Provider Demographics
NPI:1083667612
Name:FARMINGTON CLINIC COMPANY LLC
Entity Type:Organization
Organization Name:FARMINGTON CLINIC COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO CAPELLA HEALTHCARE
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:615-764-3049
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:573-756-3662
Mailing Address - Fax:573-756-3640
Practice Address - Street 1:1212 WEBER RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3325
Practice Address - Country:US
Practice Address - Phone:573-756-3662
Practice Address - Fax:573-756-3640
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FARMINGTON CLINIC COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO503111908Medicaid
MO503111908Medicaid