Provider Demographics
NPI:1487035382
Name:PREMIER OB/GYN LLC
Entity Type:Organization
Organization Name:PREMIER OB/GYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERVEY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:602-283-3668
Mailing Address - Street 1:1300 N 12TH ST STE 620
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2850
Mailing Address - Country:US
Mailing Address - Phone:602-283-3668
Mailing Address - Fax:
Practice Address - Street 1:1300 N 12TH ST STE 620
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2850
Practice Address - Country:US
Practice Address - Phone:602-283-3668
Practice Address - Fax:833-471-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty