Healthcare Provider Details

I. General information

NPI: 1992467682
Provider Name (Legal Business Name): MIDWEST SURGICAL CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2021
Last Update Date: 11/14/2021
Certification Date: 11/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 BUCKHURST CT
BALLWIN MO
63021-8395
US

IV. Provider business mailing address

1503 BUCKHURST CT
BALLWIN MO
63021-8395
US

V. Phone/Fax

Practice location:
  • Phone: 618-616-1658
  • Fax:
Mailing address:
  • Phone: 618-616-1658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: REBECCA MARIE HRUSKA
Title or Position: OWNER
Credential: OPA-C, CST/CSFA
Phone: 618-616-1658