Organization
FARMINGTON CLINIC COMPANY LLC
Active
Parent organization
FARMINGTON CLINIC COMPANY LLC
Other names
Mineral Area Primary Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
FARMINGTON CLINIC COMPANY LLC
Authorized official
DEBBIE E BREWER MBA (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9813
Entity
Organization
Contact information
Practice address
1101 WEBER RD, SUITE 101, FARMINGTON, MO 63640-3326
(573) 756-5701
(573) 756-7107
Mailing address
PO BOX 504354, SAINT LOUIS, MO 63150-0001
(573) 756-5701
(573) 756-7107
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15057
MEDICARE GROUP NUMBER
MO
Enumeration date
09/22/2006
Last updated
07/21/2022
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