Provider Demographics
NPI:1487616256
Name:GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:125 E LOCKLING ST
Mailing Address - Street 2:P.O. BOX 408
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628-2367
Mailing Address - Country:US
Mailing Address - Phone:660-258-8237
Mailing Address - Fax:660-258-4002
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:660-258-1050
Practice Address - Fax:660-258-1052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERAL JOHN J. PERSHING MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-05
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO503898603Medicaid
MO596059501Medicaid
MO000012991Medicare ID - Type UnspecifiedNON-RURAL HEALTH
MO596059501Medicaid
MOCF8677Medicare ID - Type UnspecifiedRAILROAD MEDICARE