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General NPI Number Information
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NPI Number | 1003057456
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Entity Type | Organization
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Legal Business Name | PREMIER OB-GYN PLLC
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Dates
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Enumeration Date | 03/16/2009
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Last Update Date | 01/29/2010
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Provider Practice Location Address
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Address Line | 9195 GRANT ST SUITE 400
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City | THORNTON
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State | CO
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Zip | 80229-4385
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Country | US
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Telephone | 303-854-3681
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Fax | 303-426-4154
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Provider Business Mailing Address
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Address Line | 9195 GRANT ST SUITE 400
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City | THORNTON
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State | CO
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Zip | 80229-4385
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Country | US
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Telephone | 303-854-3681
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Fax | 303-426-4154
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Authorized Official
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Title or Position | MD
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Name | STACEY HENNESY
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Credential |
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Telephone | 303-854-3681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 40865
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License Number State | CO
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