Healthcare Provider Details

I. General information

NPI: 1437585916
Provider Name (Legal Business Name): FOREST PARK MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2013
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 S BRENTWOOD BLVD SUITE 1250
SAINT LOUIS MO
63117-1223
US

IV. Provider business mailing address

1034 S BRENTWOOD BLVD SUITE 1250
SAINT LOUIS MO
63117-1223
US

V. Phone/Fax

Practice location:
  • Phone: 314-367-6600
  • Fax: 314-367-5982
Mailing address:
  • Phone: 314-367-6600
  • Fax: 314-367-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES E GREENWALD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-367-6600