Contacts | Authorizing Official | Update | AO Change Request | Burge, Eugene
CEO
Savoy Medical Center
3374680355 | Denton, Brian
CEO
Savoy Medical Center
3374680350 | 12/19/2024 11:34 AM |
Details | Last Recertification Date | Update | Recertification | 8/21/2023 12:20:06 PM | 8/23/2024 11:22:13 AM | 8/23/2024 11:22 AM |
Addresses | Billing Address | Insert | Group Change Request | | SAVOY MEDICAL MANAGEMENT GROUP, INC. D/B/A SAVOY MEDICAL CENTER
801 POINCIANA AVENUE
MAMOU, LA 70554 | 7/18/2024 12:40 PM |
Addresses | Shipping Address | Insert | Group Change Request | | SAVOY MEDICAL MANAGEMENT GROUP, INC. D/B/A SAVOY MEDICAL CENTER
801 POINCIANA AVENUE
MAMOU, LA 70554 | 7/18/2024 12:40 PM |
Contacts | Authorizing Official | Update | AO Change Request | Soileau, Michelle
CFO
Savoy Medical Center
3374680154 | Burge, Eugene
CEO
Savoy Medical Center
3374680355 | 6/11/2024 8:05 AM |
Contacts | Authorizing Official | Update | AO Change Request | ARMENTOR, LANCE
CEO
SAVOY MEDICAL MANAGEMENT GROUP, INC.
3374680350 | Soileau, Michelle
CFO
Savoy Medical Center
3374680154 | 3/18/2024 10:56 AM |
Details | Last Recertification Date | Update | Recertification | 8/30/2022 1:19:36 PM | 8/21/2023 12:20:06 PM | 8/21/2023 12:20 PM |
Details | Last Recertification Date | Update | Recertification | 8/26/2021 4:18:22 PM | 8/30/2022 1:19:36 PM | 8/30/2022 1:19 PM |
Contacts | Authorizing Official | Update | AO Change Request | Burge, Eugene
CEO
Savoy Medical Center
3374680355 | ARMENTOR, LANCE
CEO
SAVOY MEDICAL MANAGEMENT GROUP, INC.
3374680350 | 1/12/2022 7:11 AM |
Details | Last Recertification Date | Update | Recertification | 9/4/2020 10:22:41 AM | 8/26/2021 4:18:22 PM | 8/26/2021 4:18 PM |
Medicaid Billing | NPI: State | Update | Recertification | | LA | 9/4/2020 10:22 AM |
Details | Last Recertification Date | Update | Recertification | 9/10/2019 12:05:30 PM | 9/4/2020 10:22:41 AM | 9/4/2020 10:22 AM |
Details | Last Recertification Date | Update | Recertification | 8/30/2018 2:33:44 PM | 9/10/2019 12:05:30 PM | 9/10/2019 12:05 PM |
Details | Last Recertification Date | Update | Recertification | 11/16/2017 10:24:10 AM | 8/30/2018 2:33:44 PM | 8/30/2018 2:33 PM |
Details | Entity Name | Update | Recertification | SAVOY MEDICAL MANAGEMENT GROUP INC. | SAVOY MEDICAL MANAGEMENT GROUP, INC. D/B/A SAVOY MEDICAL CENTER | 11/16/2017 11:01 AM |
Details | Last Recertification Date | Update | Recertification | | 11/16/2017 10:24:10 AM | 11/16/2017 10:24 AM |
Contacts | Authorizing Official | Update | | Burge, Eugene
CEO
3374680355 | Burge, Eugene
CEO
Savoy Medical Center
3374680355 | 9/29/2017 2:17 PM |
Contacts | Primary Contact | Update | | Pitre, John
Pharmacy Director
3374680149 | Pitre, John
Pharmacy Director
Savoy Medical Center
3374680149 | 9/29/2017 12:13 PM |
Addresses | Main Address | Insert | | |
1610 7TH ST
MAMOU, LA 70554-2299 | 6/15/2017 2:45 PM |
Contacts | Authorizing Official | Insert | | | Burge, Eugene
CEO
3374680355 | 6/15/2017 2:45 PM |
Contacts | Primary Contact | Insert | | | Pitre, John
Pharmacy Director
3374680149 | 6/15/2017 2:45 PM |
Contacts | Signed By | Insert | | | Fookes, Sherman
CEO
SAVOY MEDICAL MANAGEMENT GROUP INC.
3374680350 | 6/15/2017 2:45 PM |
Dates | Participating Approval Date | Update | | | 8/19/2016 12:00:00 AM | 8/19/2016 11:17 AM |
Details | State | Update | | Pending | Active | 8/19/2016 11:17 AM |
Dates | Start Date | Update | | | 10/1/2016 12:00:00 AM | 8/19/2016 11:17 AM |
Details | 340B ID | Update | | OUTPATIENT_ONLINE_REG_71905 | DSH190025C | 8/2/2016 11:21 AM |
Details | Entity Subname | Update | | NEW HORIZONS / New Horizons - Psych | NEW HORIZONS / Psych | 8/2/2016 11:21 AM |
Details | 340B ID | Update | | | OUTPATIENT_ONLINE_REG_71905 | 7/15/2016 11:29 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 7/15/2016 11:29 AM |
Medicaid Billing | Medicaid: Number | Insert | | | 1766062 | 7/15/2016 11:29 AM |
Medicaid Billing | Medicaid: State | Insert | | | LA | 7/15/2016 11:29 AM |
Medicaid Billing | NPI: Number | Insert | | | 1255667002 | 7/15/2016 11:29 AM |
Details | Last Recertification Date | Insert | | | | 7/15/2016 11:29 AM |
Details | Grant Number | Insert | | | | 7/15/2016 11:29 AM |
Details | 340B ID | Insert | | | | 7/15/2016 11:29 AM |
Details | Is Authorizing Official EHB Data | Insert | | | | 7/15/2016 11:29 AM |
Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/15/2016 11:29 AM |
Details | Medicare Provider Number | Insert | | | 190025 | 7/15/2016 11:29 AM |
Details | Entity Name | Insert | | | SAVOY MEDICAL MANAGEMENT GROUP INC. | 7/15/2016 11:29 AM |
Details | Program Code | Insert | | | DSH | 7/15/2016 11:29 AM |
Details | Entity Subname | Insert | | | NEW HORIZONS / New Horizons - Psych | 7/15/2016 11:29 AM |
Dates | Participating Approval Date | Insert | | | | 7/15/2016 11:29 AM |
Details | State | Insert | | | Pending | 7/15/2016 11:29 AM |
Dates | Registration Date | Insert | | | 7/15/2016 12:00:00 AM | 7/15/2016 11:29 AM |
Dates | Signed By Date | Insert | | | 7/15/2016 12:00:00 AM | 7/15/2016 11:29 AM |
Dates | Start Date | Insert | | | | 7/15/2016 11:29 AM |
Terminations | Termination Comments | Insert | | | | 7/15/2016 11:29 AM |
Terminations | Termination Date | Insert | | | | 7/15/2016 11:29 AM |
Terminations | Termination Effective Date | Insert | | | | 7/15/2016 11:29 AM |
Terminations | Termination Reason | Insert | | | | 7/15/2016 11:29 AM |