Provider Demographics
NPI:1396799938
Name:PREMIER OB/GYN, LLC
Entity type:Organization
Organization Name:PREMIER OB/GYN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-392-6600
Mailing Address - Street 1:5419 N LOVINGTON HWY
Mailing Address - Street 2:COMPLEX # 5, SUITE 6
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-9100
Mailing Address - Country:US
Mailing Address - Phone:505-392-6600
Mailing Address - Fax:505-392-4071
Practice Address - Street 1:5419 N LOVINGTON HWY
Practice Address - Street 2:COMPLEX # 5, SUITE 6
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9100
Practice Address - Country:US
Practice Address - Phone:505-392-6600
Practice Address - Fax:505-392-4071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM2003-0670207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM$$$$$$$$$OtherSOCIAL SECURITY NUMBER
NM207V00000XOtherTAXANOMY CODE
NJ$$$$$$$$$OtherSOCIAL SECURITY NUMBER
NM88422747Medicaid
NM43805809Medicaid
NM6677206Medicaid
NM$$$$$$$$$OtherSOCIAL SECURITY NUMBER
NM207V00000XOtherTAXONOMY CODE
NM363LW0102XOtherTAXONOMY CODE
NM207V00000XOtherTAXONOMY CODE