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1063517613 NPI number — FARMINGTON CLINIC COMPANY LLC

NPI Number: 1063517613
Health Care Provider/Practitioner: FARMINGTON CLINIC COMPANY LLC

Information about “1063517613” NPI (FARMINGTON CLINIC COMPANY LLC) exists in 1063517613 in HTML format HTML  |  1063517613 in plain Text format TXT  |  1063517613 in PDF (Portable Document Format) PDF  |  1063517613 in an XML format XML  formats.

NPI Number : 1063517613 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063517613",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "FARMINGTON CLINIC COMPANY LLC",
    "ParentOrgTIN": null,
    "OrgName": "FARMINGTON CLINIC COMPANY LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 504354",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63150-0001",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "573-783-4683",
    "MailingAddressFaxNumber": "573-783-4684",
    "FirstLinePracticeLocationAddress": "309 GARRETT ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FREDERICKTOWN",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63645-1084",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "573-783-4683",
    "PracticeLocationAddressFaxNumber": "573-783-4684",
    "EnumerationDate": "09/14/2006",
    "LastUpdateDate": "07/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PORTACCI",
    "AuthorizedOfficialFirstName": "MICHAEL",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "615-465-7029",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QR1300X",
          "TaxonomyName": "Rural Health Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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