Provider Demographics
NPI:1225807530
Name:PREMIER OB-GYN OF TEXAS LLC
Entity Type:Organization
Organization Name:PREMIER OB-GYN OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-659-5604
Mailing Address - Street 1:4458 MEDICAL DR STE 640
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3739
Mailing Address - Country:US
Mailing Address - Phone:702-659-5604
Mailing Address - Fax:702-660-6186
Practice Address - Street 1:4458 MEDICAL DR STE 640
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3739
Practice Address - Country:US
Practice Address - Phone:702-659-5604
Practice Address - Fax:702-660-6186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty