Provider Demographics
NPI:1417287897
Name:FARMINGTON CLINIC COMPANY LLC
Entity Type:Organization
Organization Name:FARMINGTON CLINIC COMPANY LLC
Other - Org Name:MINERAL AREA UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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 504354
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-0001
Mailing Address - Country:US
Mailing Address - Phone:573-756-8880
Mailing Address - Fax:573-756-8881
Practice Address - Street 1:1101 WEBER RD
Practice Address - Street 2:SUITE 303
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3352
Practice Address - Country:US
Practice Address - Phone:573-756-8880
Practice Address - Fax:573-756-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty