# FOREST PARK HOSPITAL CORP \#1

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- **Entity:** Organization
- **Status:** Active
- **Other names:** FAMILY MEDICINE OF ST LOUIS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538118492
- **Authorized official:** MS. JERRIE K WEITH FHFMA (BUSINESS ADVISOR)
- **Authorized official phone:** (618) 779-5508

## Contact information

- **Practice address:** 6125 CLAYTON AVE, STE 222, SAINT LOUIS, MO 63139-3265
- **Practice address phone:** (314) 768-3685
- **Practice address fax:** (314) 768-3940
- **Mailing address:** 531 PEBBLE BROOK LN, HMAI, BELLEVILLE, IL 62221-7609
- **Mailing address phone:** (618) 779-5508
- **Mailing address fax:** (618) 206-8588

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/09/2006
- **Last updated:** 08/22/2020