Provider Demographics
NPI:1417991159
Name:GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:PERSHING MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
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:P.O. BOX 408
Mailing Address - Street 2:130 E LOCKLING AVE
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628-2337
Mailing Address - Country:US
Mailing Address - Phone:660-258-1288
Mailing Address - Fax:660-258-1222
Practice Address - Street 1:130 E LOCKLING ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628-2337
Practice Address - Country:US
Practice Address - Phone:660-258-2222
Practice Address - Fax:660-258-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO19843282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO010570406Medicaid
MO010570406Medicaid