MEDICARE: PREMIER TRANSPORTATION SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1356704084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER TRANSPORTATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	3105 LINDA ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71119
Country	:	US
Telephone Number	:	318-422-7728
Fax Number	:

Provider Business Practice Location Address
First Line	:	3105 LINDA ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71119-5212
Country	:	US
Telephone Number	:	318-422-7728
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	AVERY GRIGSBY
Credential	:
Telephone Number	:	318-422-7728

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	03/31/2016

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