Healthcare Provider Details

I. General information

NPI: 1841398773
Provider Name (Legal Business Name): FARMINGTON CLINIC COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 NESBIT DR
BONNE TERRE MO
63628-1353
US

IV. Provider business mailing address

TWO CORPORATE CENTRE SUITE 200
FRANKLIN TN
37067-2662
US

V. Phone/Fax

Practice location:
  • Phone: 573-358-1480
  • Fax: 573-358-1489
Mailing address:
  • Phone: 615-764-3000
  • Fax: 615-764-3030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMO

VIII. Authorized Official

Name: DANIEL S. SLIPKOVICH
Title or Position: CEO
Credential:
Phone: 615-764-3000