| Farmington Clinic Company Llc | |
|
309 Garrett St Fredericktown MO 63645-1084 | |
| (573) 783-4683 | |
| (573) 783-4684 |
| Full Name | Farmington Clinic Company Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 309 Garrett St, Fredericktown, Missouri |
| Authorized Official Name and Position | Michael Portacci (PRESIDENT) |
| Authorized Official Contact | 6154657029 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Farmington Clinic Company Llc Po Box 504354 Saint Louis MO 63150-0001 Ph: (573) 783-4683 | Farmington Clinic Company Llc 309 Garrett St Fredericktown MO 63645-1084 Ph: (573) 783-4683 |
| NPI Number | 1063517613 |
|---|---|
| Provider Enumeration Date | 09/14/2006 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063517613 | NPI | - | NPPES |
| 15055 | Other | MO | MEDICARE GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (Missouri) | Primary |
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