Active NPI
Farmington Clinic Company LLC
Doing business as Bonne Terre Primary Care
- Family Medicine Physician
- Bonne Terre, MO
National Provider Identifier
1841398773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- FARMINGTON CLINIC COMPANY LLC
- Doing business as
- Bonne Terre Primary Care
- Practice address
- 55 Nesbit Dr
Bonne Terre, MO 63628-1353 - Phone
- (573) 358-1480
- Fax
- (573) 358-1489
- NPI assigned
- Sep 21, 2006
- Last updated
- Jul 21, 2022
- Organization subpart
- Yes
- Parent organization
- FARMINGTON CLINIC COMPANY LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Daniel S. Slipkovich
- Title
- Ceo
- Phone
- (615) 764-3000
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | NU | ||
| Family Medicine Physician | 207Q00000X | MO | Primary |
Addresses
Primary practice location
55 Nesbit Dr
Bonne Terre, MO 63628-1353
Mailing address
Two Corporate Centre
Suite 200
Franklin, TN 37067-2662
Phone (615) 764-3000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 504907908 | Medicaid | MO | |
| 15054 | Other | MO | MEDICARE GROUP NUMBER |
Other names 1
- Bonne Terre Primary Care
National Provider Directory
National Provider Directory- Part of
- Farmington Clinic Company LLC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1841398773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "TWO CORPORATE CENTRE",
"address_2": "SUITE 200",
"city": "FRANKLIN",
"state": "TN",
"postal_code": "370672662",
"telephone_number": "615-764-3000",
"fax_number": "615-764-3030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 NESBIT DR",
"city": "BONNE TERRE",
"state": "MO",
"postal_code": "636281353",
"telephone_number": "573-358-1480",
"fax_number": "573-358-1489"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FARMINGTON CLINIC COMPANY LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FARMINGTON CLINIC COMPANY LLC",
"enumeration_date": "2006-09-21",
"last_updated": "2022-07-21",
"status": "A",
"authorized_official_last_name": "SLIPKOVICH",
"authorized_official_first_name": "DANIEL",
"authorized_official_middle_name": "S.",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "615-764-3000"
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MO",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "504907908",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP NUMBER",
"identifier": "15054",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Bonne Terre Primary Care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bonne Terre, MO
Sources for this page
- 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.