# FARMINGTON CLINIC COMPANY LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FARMINGTON CLINIC COMPANY LLC
- **Other names:** Fredericktown Primary Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1063517613
- **Legal business name:** FARMINGTON CLINIC COMPANY LLC
- **Authorized official:** MICHAEL PORTACCI (PRESIDENT)
- **Authorized official phone:** (615) 465-7029

## Contact information

- **Practice address:** 309 GARRETT ST, FREDERICKTOWN, MO 63645-1084
- **Practice address phone:** (573) 783-4683
- **Practice address fax:** (573) 783-4684
- **Mailing address:** PO BOX 504354, SAINT LOUIS, MO 63150-0001
- **Mailing address phone:** (573) 783-4683
- **Mailing address fax:** (573) 783-4684

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | MO | Yes |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 09/14/2006
- **Last updated:** 07/21/2022