Healthcare Provider Details

I. General information

NPI: 1740389881
Provider Name (Legal Business Name): FARMINGTON CLINIC COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 WEBER RD STE 204
FARMINGTON MO
63640-3300
US

IV. Provider business mailing address

PO BOX 9489
BELFAST ME
04915-9489
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-4200
  • Fax: 573-756-1904
Mailing address:
  • Phone: 573-756-3662
  • Fax: 573-756-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMO

VIII. Authorized Official

Name: DANIEL S. SLIPKOVICH
Title or Position: CEO CAPELLA HEALTHCARE
Credential:
Phone: 615-764-3049