Farmington Clinic Company LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FARMINGTON CLINIC COMPANY LLC

Doing business as

Fredericktown Primary Care

Practice address

309 Garrett St
Fredericktown, MO 63645-1084

Phone

(573) 783-4683

Fax

(573) 783-4684

NPI assigned

Sep 14, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

FARMINGTON CLINIC COMPANY LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Portacci

Title

President

Phone

(615) 465-7029

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Fredericktown Primary Care Doing business as

Part of

Farmington Clinic Company LLC

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Victoria A Damba, DO

  • Family Medicine Physician
  • Perryville, MO
  • NPI 1326099607
  NPD (past)
• Glen A Mohan, CFNP

  • Family Nurse Practitioner
  • Farmington, MO
  • NPI 1457303968
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1063517613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 504354",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631500001",
            "telephone_number": "573-783-4683",
            "fax_number": "573-783-4684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 GARRETT ST",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636451084",
            "telephone_number": "573-783-4683",
            "fax_number": "573-783-4684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FARMINGTON CLINIC COMPANY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FARMINGTON CLINIC COMPANY LLC",
        "enumeration_date": "2006-09-14",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PORTACCI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-465-7029"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "15055",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fredericktown Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cindy Lee Dulaney, FNP-BC
• Starla Kay Dulworth, RN, MSN, BC, FNP
• East Missouri Action Agency, Inc.
• Emily Engers
• Faith Tabernacle World Outreach Inc (Faith Foundation Children's Home)
• Linda Bernard Femmer, COTA
• Melinda Jo Fischer, RN, BC, FNP
• Christine Marie Forrest, CPS
• Christa M Forsythe, CCC SLP
• Fredericktown Family Dental

• Family Medicine Physician in Fredericktown, MO
• Providers in Fredericktown, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.