Healthcare Provider Details

I. General information

NPI: 1952343758
Provider Name (Legal Business Name): FARMINGTON MISSOURI HOSPITAL COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 WEBER ROAD
FARMINGTON MO
63640
US

IV. Provider business mailing address

1212 WEBER ROAD
FARMINGTON MO
63640
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-4581
  • Fax: 573-756-5834
Mailing address:
  • Phone: 573-756-4581
  • Fax: 573-756-5834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE T BREWER
Title or Position: SR VICE PRESIDENT
Credential:
Phone: 877-892-9813