Provider Demographics
NPI:1073521555
Name:GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:PERSHING HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:660-258-1288
Mailing Address - Street 1:130 E LOCKLING AVE
Mailing Address - Street 2:P.O. BOX 408
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628-0408
Mailing Address - Country:US
Mailing Address - Phone:660-258-2222
Mailing Address - Fax:660-258-5668
Practice Address - Street 1:130 E LOCKLING AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628-0408
Practice Address - Country:US
Practice Address - Phone:660-258-2222
Practice Address - Fax:660-258-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO060-8HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO820570406Medicaid
MO261546Medicare Oscar/Certification