Provider Demographics
NPI:1144372780
Name:FOREST PARK HOSPITAL CORPORATION #1
Entity type:Organization
Organization Name:FOREST PARK HOSPITAL CORPORATION #1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-644-7040
Mailing Address - Street 1:6150 OAKLAND
Mailing Address - Street 2:FOREST PARK COMMUNITY HOSPITAL
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139
Mailing Address - Country:US
Mailing Address - Phone:314-644-7040
Mailing Address - Fax:314-865-7983
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:314-768-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO489-1273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO26S021Medicare ID - Type UnspecifiedPSYCHIATRIC SUBPROVIDER