Healthcare Provider Details

I. General information

NPI: 1689811929
Provider Name (Legal Business Name): GENERAL JOHN J PERSHING MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2009
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

130 E LOCKLING ST
BROOKFIELD MO
64628-2337
US

V. Phone/Fax

Practice location:
  • Phone: 660-258-2222
  • Fax: 660-258-5668
Mailing address:
  • Phone: 660-258-2222
  • Fax: 660-258-5668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number19843
License Number StateMO

VIII. Authorized Official

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