1407851744 NPI number — PREMIER MARKETING ASSOCIATES LTD PARTNERSHIP

Table of content: (NPI 1407851744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407851744 NPI number — PREMIER MARKETING ASSOCIATES LTD PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER MARKETING ASSOCIATES LTD PARTNERSHIP
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:
MILLENNIUM MEDICAL
Provider Other Organization Name Type Code:
3
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:
1407851744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7591 FERN AVE
Provider Second Line Business Mailing Address:
STE. 1301
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71105-5750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-424-4150
Provider Business Mailing Address Fax Number:
318-424-4181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7591 FERN AVE
Provider Second Line Business Practice Location Address:
STE. 1301
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71105-5750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-424-4150
Provider Business Practice Location Address Fax Number:
318-424-4181
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
318-424-4150

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00040098 . This is a "MEDICAID" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 0017951970003 . This is a "MEDICAID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0748733-01 . This is a "MEDICAID DME ONLY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0748733-03 . This is a "MEDICAID WHEELCHAIR/REHAB" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0136891 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 00203704 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 017802100 . This is a "MEDICAID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4581514 . This is a "MEDICAID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 62821831 . This is a "MEDICAID" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 009998800 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 623236 . This is a "TRIGON BC/BS ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90012378 . This is a "MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 49013 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 9105867 . This is a "MEDICAID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 100802330B . This is a "MEDICAID" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 1910635 . This is a "MEDICAID" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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