Healthcare Provider Details

I. General information

NPI: 1487616256
Provider Name (Legal Business Name): GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E LOCKLING ST
BROOKFIELD MO
64628-2337
US

IV. Provider business mailing address

125 E LOCKLING ST P.O. BOX 408
BROOKFIELD MO
64628-2367
US

V. Phone/Fax

Practice location:
  • Phone: 660-258-1050
  • Fax: 660-258-1052
Mailing address:
  • Phone: 660-258-8237
  • Fax: 660-258-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH E BARANSKI
Title or Position: CFO
Credential: CPA
Phone: 660-258-1288