Provider Demographics
NPI:1386921195
Name:FARMINGTON CLINIC COMPANY, LLC
Entity type:Organization
Organization Name:FARMINGTON CLINIC COMPANY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SLIPKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-756-5787
Mailing Address - Street 1:PO BOX 9489
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9489
Mailing Address - Country:US
Mailing Address - Phone:573-756-5787
Mailing Address - Fax:573-756-4206
Practice Address - Street 1:1101 WEBER RD
Practice Address - Street 2:SUITE 302
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3352
Practice Address - Country:US
Practice Address - Phone:573-756-5787
Practice Address - Fax:573-756-4206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty