# FARMINGTON CLINIC COMPANY LLC

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

## Provider details

- **NPI number:** 1962501098
- **Legal business name:** FARMINGTON CLINIC COMPANY LLC
- **Authorized official:** MICHAEL PORTACCI (PRESIDENT)
- **Authorized official phone:** (615) 465-7029

## Contact information

- **Practice address:** 751 MAPLE VALLEY DR, FARMINGTON, MO 63640-1944
- **Practice address phone:** (573) 756-1800
- **Practice address fax:** (573) 756-4476
- **Mailing address:** PO BOX 504354, SAINT LOUIS, MO 63150-0001
- **Mailing address phone:** (573) 756-1800
- **Mailing address fax:** (573) 756-4476

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | MO | Yes |

## Other

- **Enumeration date:** 09/22/2006
- **Last updated:** 07/21/2022