1700939105 NPI number — FOREST PARK HOSPITAL CORPORATION

Table of content: (NPI 1700939105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700939105 NPI number — FOREST PARK HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOREST PARK HOSPITAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700939105
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
999 YAMATO RD
Provider Second Line Business Mailing Address:
THIRD FLOOR
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33431-4477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-869-3100
Provider Business Mailing Address Fax Number:
561-826-0171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6150 OAKLAND AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63139-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-768-3699
Provider Business Practice Location Address Fax Number:
314-768-3990
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUNN
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
561-869-6300

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  511-1 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10634608 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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