Healthcare Provider Details

I. General information

NPI: 1285995944
Provider Name (Legal Business Name): GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E HAYWARD ST
MEADVILLE MO
64659-9201
US

IV. Provider business mailing address

101 E HAYWARD ST PO BOX 131
MEADVILLE MO
64659-9201
US

V. Phone/Fax

Practice location:
  • Phone: 660-938-4213
  • Fax: 660-938-4211
Mailing address:
  • Phone: 660-938-4213
  • Fax: 660-938-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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