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General NPI Number Information
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NPI Number | 1417991159
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Entity Type | Organization
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Legal Business Name | GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 130 E LOCKLING ST
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City | BROOKFIELD
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State | MO
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Zip | 64628-2337
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Country | US
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Telephone | 660-258-2222
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Fax | 660-258-1222
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Provider Business Mailing Address
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Address Line | P.O. BOX 408 130 E LOCKLING AVE
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City | BROOKFIELD
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State | MO
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Zip | 64628-2337
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Country | US
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Telephone | 660-258-1288
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Fax | 660-258-1222
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Authorized Official
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Title or Position | CFO
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Name | MR. KENNETH E BARANSKI
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Credential | CPA
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Telephone | 660-258-1288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 19843
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License Number State | MO
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