Provider Demographics
NPI:1851409486
Name:MEDICAL SPECIALTIES PA
Entity Type:Organization
Organization Name:MEDICAL SPECIALTIES PA
Other - Org Name:ROBERT BRUST MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-662-2270
Mailing Address - Street 1:2020 N WALDRON
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502
Mailing Address - Country:US
Mailing Address - Phone:620-662-2270
Mailing Address - Fax:620-669-9226
Practice Address - Street 1:2020 N WALDRON
Practice Address - Street 2:SUITE 105
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502
Practice Address - Country:US
Practice Address - Phone:620-662-2270
Practice Address - Fax:620-669-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSDE1144OtherRAILROAD MEDICARE
KS111179OtherBCBS
KSDE1144OtherRAILROAD MEDICARE