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Organization
FARMINGTON CLINIC COMPANY LLC
Active
Organization
FARMINGTON CLINIC COMPANY LLC
Active
Parent organization
FARMINGTON CLINIC COMPANY LLC
Other names
Fredericktown Primary Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
FARMINGTON CLINIC COMPANY LLC
Authorized official
MICHAEL PORTACCI (PRESIDENT)
(615) 465-7029
Entity
Organization
Contact information
Practice address
309 GARRETT ST, FREDERICKTOWN, MO 63645-1084
(573) 783-4683
(573) 783-4684
Mailing address
PO BOX 504354, SAINT LOUIS, MO 63150-0001
(573) 783-4683
(573) 783-4684
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
MO
261QR1300X
Rural Health Clinic/Center
—
NULL
Other
Enumeration date
09/14/2006
Last updated
07/21/2022
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