Organization
PREMIER MARKETING ASSOCIATES LTD PARTNERSHIP
Active
Other names
Millennium Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES D GRAY JR. (CHIEF OPERATING OFFICER)
(318) 424-4150
Entity
Organization
Contact information
Practice address
7591 FERN AVE, STE. 1301, SHREVEPORT, LA 71105-5750
(318) 424-4150
(318) 424-4181
Mailing address
7591 FERN AVE, STE. 1301, SHREVEPORT, LA 71105-5750
(318) 424-4150
(318) 424-4181
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00040098
MEDICAID
MS
01
—
0017951970003
MEDICAID
PA
01
—
00203704
BLUE CROSS BLUE SHIELD
PA
05
—
009998800
—
AL
01
—
0136891
BLUE CROSS BLUE SHIELD
TN
01
—
017802100
MEDICAID
MD
01
—
0748733-01
MEDICAID DME ONLY
TX
01
—
0748733-03
MEDICAID WHEELCHAIR/REHAB
TX
01
—
100802330B
MEDICAID
OK
01
—
1910635
MEDICAID
LA
01
—
4581514
MEDICAID
TN
01
—
49013
BLUE CROSS BLUE SHIELD
LA
01
—
623236
TRIGON BC/BS ANTHEM
—
01
—
62821831
MEDICAID
NM
01
—
90012378
MEDICAID
KY
01
—
9105867
MEDICAID
VA
Enumeration date
06/14/2005
Last updated
03/01/2017
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