Basic Information
| Provider Information | |||||||||
| NPI: | 1134184997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERQUIST | ||||||||
| FirstName: | KENT | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 S SANTA FE AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674014190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854527269 | ||||||||
| FaxNumber: | 7854526008 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 S SANTA FE AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674014190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854527325 | ||||||||
| FaxNumber: | 7854526570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 05/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | 04-20678 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RP1001X | 04-20678 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | 0420678 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100114130C | 05 | KS | MEDICAID |