1326349580 NPI number — SAVOY MEDICAL MANAGEMENT GROUP, INC

Table of content: (NPI 1326349580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326349580 NPI number — SAVOY MEDICAL MANAGEMENT GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAVOY MEDICAL MANAGEMENT GROUP, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326349580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
803 POINCIANA AVE, STE. C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAMOU
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70554-2201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-468-4038
Provider Business Mailing Address Fax Number:
337-468-4042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
803 POINCIANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAMOU
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70554-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-468-4038
Provider Business Practice Location Address Fax Number:
337-468-4042
Provider Enumeration Date:
11/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BURGE
Authorized Official First Name:
EUGENE
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
337-468-0355

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  PENDING , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5DS33 . This is a "MEDICARE GROUP" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 198510 . This is a "MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 2489291 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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