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NPI Code Detail

MEDICARE: GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION

MEDICARE: GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1282NC0060XCritical Access Hospital19843MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417991159
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Provider Business Mailing Address
First Line : P.O. BOX 408
Second Line : 130 E LOCKLING AVE
City : BROOKFIELD
State : MO
Zip : 64628-2337
Country : US
Telephone Number : 660-258-1288
Fax Number : 660-258-1222
Provider Business Practice Location Address
First Line : 130 E LOCKLING ST
Second Line :
City : BROOKFIELD
State : MO
Zip : 64628-2337
Country : US
Telephone Number : 660-258-2222
Fax Number : 660-258-1222
Authorized Official
Title or Position : CFO
Name : MR. KENNETH E BARANSKI
Credential : CPA
Telephone Number : 660-258-1288
Provider Enumeration Date : 06/15/2006
Last Update Date : 11/08/2023

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