1174979439 NPI number — GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION

Table of content: (NPI 1174979439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174979439 NPI number — GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENERAL JOHN J PERSHING MEMORIAL HOSPITAL ASSOCIATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174979439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 E LOCKLING ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64628-2367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-258-1307
Provider Business Mailing Address Fax Number:
660-258-4002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 E LOCKLING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64628-2337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-258-1050
Provider Business Practice Location Address Fax Number:
660-258-1052
Provider Enumeration Date:
05/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BARANSKI
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
660-258-1288

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  19856 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 503898603 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 596059501 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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