Healthcare Provider Details

I. General information

NPI: 1700835758
Provider Name (Legal Business Name): FOREST PARK HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 OAKLAND AVE
SAINT LOUIS MO
63139-3215
US

IV. Provider business mailing address

531 PEBBLE BROOK LN HMAI
BELLEVILLE IL
62221-7609
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-3090
  • Fax: 314-768-3940
Mailing address:
  • Phone: 618-779-5508
  • Fax: 618-206-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES J O'KEEFE
Title or Position: INTERIM CHIEF EXECUTIVE OFFICER
Credential:
Phone: 314-768-3699