# JOHN J. PERSHING VAMC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659764595
- **Authorized official:** BRADFORD JOSEPH DAVIS FNP (FAMILY NURSE PRACTITIONER)
- **Authorized official phone:** (573) 776-0905

## Contact information

- **Practice address:** 1500 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3318
- **Practice address phone:** (573) 686-4151
- **Practice address fax:** (573) 778-4190
- **Mailing address:** 1500 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3318
- **Mailing address phone:** (573) 686-4151
- **Mailing address fax:** (573) 778-4190

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282NR1301X | Rural Acute Care Hospital | 2015006783 | MO | Yes |

## Other

- **Enumeration date:** 03/17/2015
- **Last updated:** 03/17/2015