MEDICARE: GARDEN CITY OB-GYN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1417825795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN CITY OB-GYN LLC

Provider Business Mailing Address
First Line	:	409 N CAMPUS DR STE 108
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-6158
Country	:	US
Telephone Number	:	620-444-5550
Fax Number	:	620-702-5183

Provider Business Practice Location Address
First Line	:	409 N CAMPUS DR STE 108
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-6158
Country	:	US
Telephone Number	:	620-805-2308
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. BRET EARL HESKETT
Credential	:	MD
Telephone Number	:	620-805-2308

Provider Enumeration Date	:	10/28/2025
Last Update Date	:	01/21/2026

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