Provider Demographics
NPI:1992467682
Name:MIDWEST SURGICAL CONSULTANTS, LLC
Entity Type:Organization
Organization Name:MIDWEST SURGICAL CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HRUSKA
Authorized Official - Suffix:
Authorized Official - Credentials:OPA-C, CST/CSFA
Authorized Official - Phone:618-616-1658
Mailing Address - Street 1:1503 BUCKHURST CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-8395
Mailing Address - Country:US
Mailing Address - Phone:618-616-1658
Mailing Address - Fax:
Practice Address - Street 1:1503 BUCKHURST CT
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-8395
Practice Address - Country:US
Practice Address - Phone:618-616-1658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-10
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical