Provider Demographics
NPI:1255446241
Name:BENRUS SURGICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:BENRUS SURGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-441-2122
Mailing Address - Street 1:6 JUNGERMANN CIR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-1625
Mailing Address - Country:US
Mailing Address - Phone:636-441-2122
Mailing Address - Fax:636-441-5290
Practice Address - Street 1:6 JUNGERMANN CIR
Practice Address - Street 2:SUITE 205
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1625
Practice Address - Country:US
Practice Address - Phone:636-441-2122
Practice Address - Fax:636-441-5290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO501880801Medicaid
MOA10271Medicare UPIN
MO990000570Medicare PIN