Basic Information
| Provider Information | |||||||||
| NPI: | 1700939105 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOREST PARK HOSPITAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 YAMATO RD | ||||||||
| Address2: | THIRD FLOOR | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334314477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618693100 | ||||||||
| FaxNumber: | 5618260171 | ||||||||
| Practice Location | |||||||||
| Address1: | 6150 OAKLAND AVENUE | ||||||||
| Address2: | |||||||||
| City: | ST. LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631393215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147683699 | ||||||||
| FaxNumber: | 3147683990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2007 | ||||||||
| LastUpdateDate: | 09/14/2010 | ||||||||
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| AuthorizedOfficialLastName: | DUNN | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5618696300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 511-1 | MO | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 10634608 | 05 | MO | MEDICAID |