Organization Name: | FARMINGTON CLINIC COMPANY LLC |
NPI Number: | 1063517613 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL PORTACCI (PRESIDENT) |
Mailing Address: | 309 Garrett St Fredericktown |
State: | MO US |
Postal Code: | 636451084 |
Phone Number: | 5737834683 |
Fax Number: | 5737834684 |
NPI Enumeration Date: | 09/14/2006 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |