| Organization Name: | LAKE FOREST EMERGENCY GROUP LLC |
| NPI Number: | 1023261716 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISHA C. F (VP OF CONTRACTING) |
| Mailing Address: | 100 Medical Plz Lake St Louis |
| State: | MO US |
| Postal Code: | 633671366 |
| Phone Number: | 6366255200 |
| Fax Number: | |
| NPI Enumeration Date: | 10/28/2008 |
| NPI Last Update Date: | 01/14/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |