# PREMIER OB-GYN LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184098212
- **Authorized official:** JODI L HENRIKSON MD (PHYSICIAN)
- **Authorized official phone:** (620) 792-2151

## Contact information

- **Practice address:** 514 CLEVELAND ST, GREAT BEND, KS 67530-3562
- **Practice address phone:** (620) 792-2151
- **Practice address fax:** (620) 793-9399
- **Mailing address:** 514 CLEVELAND ST, GREAT BEND, KS 67530-3562
- **Mailing address phone:** (620) 792-2151
- **Mailing address fax:** (620) 793-9399

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 04-30709 | KS | Yes |

## Other

- **Enumeration date:** 12/01/2015
- **Last updated:** 12/01/2015