Organization
PREMIER OB-GYN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODI L HENRIKSON MD (PHYSICIAN)
(620) 792-2151
Entity
Organization
Contact information
Practice address
514 CLEVELAND ST, GREAT BEND, KS 67530-3562
(620) 792-2151
(620) 793-9399
Mailing address
514 CLEVELAND ST, GREAT BEND, KS 67530-3562
(620) 792-2151
(620) 793-9399
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
04-30709
KS
Other
Enumeration date
12/01/2015
Last updated
12/01/2015
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