Organization
LAKE FOREST EMERGENCY GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISHA C. FALK (VP OF CONTRACTING)
(800) 893-9698
Entity
Organization
Contact information
Practice address
100 MEDICAL PLZ, LAKE ST LOUIS, MO 63367-1366
(636) 625-5200
Mailing address
200 CORPORATE BLVD, SUITE 201, LAFAYETTE, LA 70508-3870
(337) 609-1153
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/28/2008
Last updated
01/02/2020
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