Forest Park Medical Center at Southlake, LLC

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

Legal business name

FOREST PARK MEDICAL CENTER AT SOUTHLAKE, LLC

Practice address

421 East State Highway 114
Southlake, TX 76092

Phone

(817) 865-4400

Fax

(817) 865-4840

NPI assigned

Jan 24, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Nasam

Title

Ceo

Phone

(469) 330-6740

Specialties & licenses 1

Addresses

Other names 1

• FPMC Southlake Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358985600000",
    "number": "1801134903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "421 EAST STATE HIGHWAY 114",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76092",
            "telephone_number": "817-865-4400",
            "fax_number": "817-865-4840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 EAST STATE HIGHWAY 114",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76092",
            "telephone_number": "817-865-4400",
            "fax_number": "817-865-4840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST PARK MEDICAL CENTER AT SOUTHLAKE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-24",
        "last_updated": "2013-01-24",
        "status": "A",
        "authorized_official_last_name": "NASAM",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "469-330-6740"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FPMC Southlake",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Hiyas Dungo Fonte, M.D.
• Muimui Fonua
• Kaci Ford, RBT
• Traderric Ford
• Forefront Dermatology, S.C.
• Rachel Rebecca Fountain, LPC
• Jordan Fox
• Fradkin Surgical Services PLLC
• Lisa L. Fraga, M.D.
• James Francesconi, MD

• General Acute Care Hospital in Southlake, TX
• Providers in Southlake, TX by specialty
• General Acute Care Hospital in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.