Provider Demographics
NPI:1457545618
Name:PREMIER OBSTETRICS & GYNECOLOGY, P.A.
Entity Type:Organization
Organization Name:PREMIER OBSTETRICS & GYNECOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:806-296-0294
Mailing Address - Street 1:2222 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-1802
Mailing Address - Country:US
Mailing Address - Phone:806-296-0294
Mailing Address - Fax:806-296-6909
Practice Address - Street 1:2222 W 24TH ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-1802
Practice Address - Country:US
Practice Address - Phone:806-296-0294
Practice Address - Fax:806-296-6909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2662207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149437901Medicaid
TX149437901Medicaid
TXE98616Medicare UPIN