Provider Demographics
NPI:1942253067
Name:PREMIER OB/GYN OF WEST HOUSTON, LLP
Entity Type:Organization
Organization Name:PREMIER OB/GYN OF WEST HOUSTON, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:P
Authorized Official - Last Name:BARRIENTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-464-2100
Mailing Address - Street 1:PO BOX 4581
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4581
Mailing Address - Country:US
Mailing Address - Phone:713-464-2100
Mailing Address - Fax:281-392-3082
Practice Address - Street 1:18300 KATY FWY STE 315
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1386
Practice Address - Country:US
Practice Address - Phone:713-464-2100
Practice Address - Fax:281-392-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1803926-01Medicaid
0045NHOtherBCBS
TX1803926-01Medicaid