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General NPI Number Information
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NPI Number | 1750480885
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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 | 09/22/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1101 WEBER RD SUITE 101
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City | FARMINGTON
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State | MO
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Zip | 63640-3326
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Country | US
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Telephone | 573-756-5701
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Fax | 573-756-7107
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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 | 573-756-5701
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Fax | 573-756-7107
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Authorized Official
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Title or Position | DIRECTOR OF PROVIDER ENROLLMENT
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Name | DEBBIE E BREWER
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Credential | MBA
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Telephone | 877-892-9813
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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 | MO
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