PREMIER MARKETING ASSOCIATES LTD PARTNERSHIP

Provider Demographics

• NPI: 1407851744
• Name: PREMIER MARKETING ASSOCIATES LTD PARTNERSHIP
• Entity Type: Organization
• Organization Name: PREMIER MARKETING ASSOCIATES LTD PARTNERSHIP
• Other - Org Name: MILLENNIUM MEDICAL
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: CHIEF OPERATING OFFICER
• Authorized Official - Prefix: MR
• Authorized Official - First Name: CHARLES
• Authorized Official - Middle Name: D
• Authorized Official - Last Name: GRAY
• Authorized Official - Suffix: JR
• Authorized Official - Phone: 318-424-4150
• Mailing Address - Street 1: 7591 FERN AVE
• Mailing Address - Street 2: STE. 1301
• Mailing Address - City: SHREVEPORT
• Mailing Address - State: LA
• Mailing Address - Zip Code: 71105-5750
• Mailing Address - Country: US
• Mailing Address - Phone: 318-424-4150
• Mailing Address - Fax: 318-424-4181
• Practice Address - Street 1: 7591 FERN AVE
• Practice Address - Street 2: STE. 1301
• Practice Address - City: SHREVEPORT
• Practice Address - State: LA
• Practice Address - Zip Code: 71105-5750
• Practice Address - Country: US
• Practice Address - Phone: 318-424-4150
• Practice Address - Fax: 318-424-4181
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-06-14
• Last Update Date: 2017-03-01

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MS	00040098	Other	MEDICAID
PA	0017951970003	Other	MEDICAID
TX	0748733-01	Other	MEDICAID DME ONLY
TX	0748733-03	Other	MEDICAID WHEELCHAIR/REHAB
TN	0136891	Other	BLUE CROSS BLUE SHIELD
PA	00203704	Other	BLUE CROSS BLUE SHIELD
MD	017802100	Other	MEDICAID
TN	4581514	Other	MEDICAID
NM	62821831	Other	MEDICAID
AL	009998800	Medicaid
	623236	Other	TRIGON BC/BS ANTHEM
KY	90012378	Other	MEDICAID
LA	49013	Other	BLUE CROSS BLUE SHIELD
VA	9105867	Other	MEDICAID
OK	100802330B	Other	MEDICAID
LA	1910635	Other	MEDICAID
TN	0136891	Other	BLUE CROSS BLUE SHIELD
KY	90012378	Other	MEDICAID
TN	0136891	Other	BLUE CROSS BLUE SHIELD
TX	0748733-03	Other	MEDICAID WHEELCHAIR/REHAB