FARMINGTON CLINIC COMPANY LLC (NPI# 1063517613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063517613 |
| Entity Type | Organization |
| Organization Name | FARMINGTON CLINIC COMPANY LLC |
| Other Organization Name | FREDERICKTOWN PRIMARY CARE |
| Practice Address |
309 Garrett St Fredericktown MO 63645-1084 |
| Mailing Address |
Po Box 504354 Saint Louis MO 63150-0001 |
| Practice Telephone | 5737834683 |
| Practice Fax Number | 5737834684 |
| Mailing Telephone | 5737834683 |
| Mailing Fax Number | 5737834684 |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2018-06-20 |
| Authorized Official Name | MICHAEL PORTACCI (PRESIDENT) |
| Authorized Official Telephone | 6154657029 |
| Is Organization Subpart | Y |
| Parent Organization Name | FARMINGTON CLINIC COMPANY LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities | ||
| Y | 207Q00000X | Family Medicine | ========= | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | MEDICARE GROUP NUMBER | 15055 | 01 |
| Other Name | Type Code |
|---|---|
| Fredericktown Primary Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427245240 | Farmington Clinic Company LLC | Obstetrics & Gynecology | 1216 Weber Road, Farmington, MO 63640-3325 | 2007-09-25 |
| 1427244482 | Farmington Clinic Company LLC | Orthopaedic Surgery | Post Office Box 504354, St. Louis, St. Louis, MO 63150-0001 | 2007-09-24 |
| 1740389881 | Farmington Clinic Company LLC | Family Medicine | 1101 Weber Rd Ste 204, Farmington, MO 63640-3300 | 2006-09-22 |
| 1023113917 | Farmington Clinic Company LLC | Family Medicine | 1103 Weber Rd Ste 202, Farmington, MO 63640-3302 | 2006-09-14 |
| 1023065489 | Farmington Clinic Company LLC | Family Medicine | 764 Weber Rd, Farmington, MO 63640-3317 | 2006-05-30 |
| 1063742443 | Farmington Clinic Company LLC | Orthopaedic Surgery | 1101 Weber Rd, Suite 203, Farmington, MO 63640-3352 | 2010-01-06 |
| 1417287897 | Farmington Clinic Company LLC | Urology | 1101 Weber Rd, Suite 303, Farmington, MO 63640-3352 | 2010-01-06 |
| 1669661856 | Farmington Clinic Company LLC | Pediatrics | 1103 Weber Rd Ste 202, Farmington, MO 63640-3302 | 2007-10-24 |
| 1841399979 | Farmington Clinic Company LLC | Family Medicine | 1212 Weber Rd, Farmington, MO 63640-3325 | 2006-09-22 |
| 1750480885 | Farmington Clinic Company LLC | Family Medicine | 1101 Weber Rd, Suite 101, Farmington, MO 63640-3326 | 2006-09-22 |
| Street Address |
309 GARRETT ST |
| City | FREDERICKTOWN |
| State | MO |
| Zip Code | 63645-1084 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063539252 | Fred Wayne Gaskin | Psychiatry & Neurology | 309 Garrett St, Fredericktown, MO 63645-1084 | 2007-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093193880 | Emily Engers | Counselor | 206 W Marvin Ave, Fredericktown, MO 63645 | 2015-05-12 |
| 1871823955 | Covenant Care Services, LLC | Custodial Care Facility | 1610 W. Hwy 72, Fredericktown, MO 63645 | 2010-01-12 |
| 1518110279 | East Missouri Action Agency, Inc. | Clinic/Center | 806 West College Rd, Fredericktown, MO 63645 | 2008-10-28 |
| 1679737324 | Linda Carole Cravens | Dentist | 731 W Main St, Guy A Walker Dds, Fredericktown, MO 63645 | 2008-07-11 |
| 1629286976 | Community Health Care Associates, Inc | Social Worker | 735 West Main, Fredericktown, MO 63645 | 2007-05-18 |
| 1467539031 | Madison Medical Center Stockhoff Memorial Nursing Home | Clinic/Center | 611 West Main Street, Fredericktown, MO 63645 | 2006-11-01 |
| 1487749537 | Covenant Care Services, LLC | Registered Nurse | 120 S. Mine Lamotte, Fredericktown, MO 63645 | 2006-10-04 |
| 1215577945 | Modern Mental Health | Community/Behavioral Health | 151 South Main Street, Suite B, Fredericktown, MO 63645 | 2020-01-10 |
| 1235392309 | Humberto Jose Olivero Lara | Family Medicine | 611 West Main Street, Fredericktown, MO 63645 | 2008-07-08 |
| 1003983859 | Madison Memorial Hospital Stockhoff Memorial Nursing Home | Pharmacy | 611 West Main Street, Fredericktown, MO 63645 | 2006-11-29 |
| Find all providers in zip 63645 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114060472 | Fredericktown Family Practice | Family Medicine | 16361 Village Pkwy, Fredericktown, OH 43019-9585 | 2007-02-15 |
| 1881705564 | Michael D Robbins | Family Medicine | 355 N Chamber Dr, Fredericktown, MO 63645-7947 | 2006-08-31 |
| 1821032152 | Matthew Bradley Smith | Family Medicine | 122 Columbus Rd, Fredericktown, OH 43019-1266 | 2006-06-16 |
| 1407805732 | Phillip Marion Beyer | Family Medicine | 735 W Main St, Fredericktown, MO 63645-1113 | 2006-05-05 |
| 1023009198 | Yong Dae Cho | Family Medicine | 1070 Old National Pike, Fredericktown, PA 15333-2114 | 2005-10-28 |
| 1063075752 | Brandi Nichole Tabor | Family Medicine | 735 W Main St, Fredericktown, MO 63645-1113 | 2019-04-17 |
| 1134695703 | Community Health Care Associates, Inc | Family Medicine | 735 W Main St, Fredericktown, MO 63645-1113 | 2018-10-22 |
| 1124273875 | Amber Lyn Daugherty | Family Medicine | 16361 Village Pkwy, Fredericktown, OH 43019-9585 | 2008-11-21 |
| 1235392309 | Humberto Jose Olivero Lara | Family Medicine | 611 West Main Street, Fredericktown, MO 63645 | 2008-07-08 |
| 1932277498 | Eric K Davis | Family Medicine | 611 W Main St, Fredericktown, MO 63645-1111 | 2006-12-01 |
| Find all providers in FREDERICKTOWN | ||||
| City | FREDERICKTOWN |
| Zip Code | 63645 |
Please comment or provide details below to improve the information on FARMINGTON CLINIC COMPANY LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.