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General NPI Number Information
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NPI Number | 1023065489
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Entity Type | Organization
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Legal Business Name | FARMINGTON CLINIC COMPANY LLC
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 764 WEBER RD
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City | FARMINGTON
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State | MO
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Zip | 63640-3317
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Country | US
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Telephone | 573-756-2123
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Fax | 573-756-2761
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Provider Business Mailing Address
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Address Line | PO BOX 9489
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City | BELFAST
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State | ME
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Zip | 04915-9489
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Country | US
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Telephone | 573-756-2123
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Fax | 573-756-2761
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Authorized Official
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Title or Position | CFO
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Name | MR. DONALD MCDANIEL
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Credential |
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Telephone | 573-756-4581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 000014942
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 184-46
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License Number State | MO
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