Basic Information
| Provider Information | |||||||||
| NPI: | 1346392420 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOREST PARK HOSPITAL CORPPORATION #1 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6150 OAKLAND AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631393215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147683000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6150 OAKLAND AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631393215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147683000 | ||||||||
| FaxNumber: | 4809487104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 01/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | TUFT | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4803481099 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 489-1 | MO | Y | Hospital Units | Rehabilitation Unit |
No ID Information.