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General NPI Number Information
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NPI Number | 1073748828
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Entity Type | Organization
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Legal Business Name | FOREST PARK CRITICAL CARE LLC
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Dates
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Enumeration Date | 05/22/2009
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Last Update Date | 07/31/2009
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Provider Practice Location Address
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Address Line | 6150 OAKLAND AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63139-3215
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Country | US
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Telephone | 314-209-9331
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Fax | 314-447-0155
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Provider Business Mailing Address
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Address Line | PO BOX 240311
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City | BALLWIN
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State | MO
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Zip | 63024-0311
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Country | US
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Telephone | 314-209-9331
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Fax | 314-447-0155
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TSHISWAKA KAYEMBE
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Credential | M.D.
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Telephone | 314-209-9331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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