Provider Demographics
NPI:1073748828
Name:FOREST PARK CRITICAL CARE LLC
Entity Type:Organization
Organization Name:FOREST PARK CRITICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TSHISWAKA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYEMBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-209-9331
Mailing Address - Street 1:PO BOX 240311
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63024-0311
Mailing Address - Country:US
Mailing Address - Phone:314-209-9331
Mailing Address - Fax:314-447-0155
Practice Address - Street 1:6150 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3215
Practice Address - Country:US
Practice Address - Phone:314-209-9331
Practice Address - Fax:314-447-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty