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General NPI Number Information
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NPI Number | 1063742443
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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 | 01/06/2010
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Last Update Date | 01/07/2010
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Provider Practice Location Address
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Address Line | 1101 WEBER RD SUITE 203
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City | FARMINGTON
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State | MO
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Zip | 63640-3352
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Country | US
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Telephone | 573-756-2600
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Fax | 573-756-2615
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Provider Business Mailing Address
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Address Line | PO BOX 504354
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City | SAINT LOUIS
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State | MO
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Zip | 63150-0001
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Country | US
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Telephone | 573-756-2600
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Fax | 573-756-2615
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Authorized Official
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Title or Position | CEO
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Name | MR. DANIEL S SLIPKOVICH
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Credential |
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Telephone | 615-764-3049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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