=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396799938
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER OB/GYN, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5419 N LOVINGTON HWY COMPLEX # 5, SUITE 6
-----------------------------------------------------
City | HOBBS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88240-9100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-392-6600
-----------------------------------------------------
Fax | 505-392-4071
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5419 N LOVINGTON HWY COMPLEX # 5, SUITE 6
-----------------------------------------------------
City | HOBBS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88240-9100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-392-6600
-----------------------------------------------------
Fax | 505-392-4071
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE ADMINISTRATOR
-----------------------------------------------------
Name | DR. ELIAS SAID
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 505-392-6600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | NM2003-0670
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------