Provider Demographics
NPI:1700835758
Name:FOREST PARK HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:FOREST PARK HOSPITAL CORPORATION
Other - Org Name:DPG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'KEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-768-3699
Mailing Address - Street 1:531 PEBBLE BROOK LN
Mailing Address - Street 2:HMAI
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-7609
Mailing Address - Country:US
Mailing Address - Phone:618-779-5508
Mailing Address - Fax:618-206-8588
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:314-768-3090
Practice Address - Fax:314-768-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO509458303Medicaid
MO000014520Medicare ID - Type UnspecifiedGROUP