Active NPI
Farmington Clinic Company LLC
- Family Medicine Physician
- Farmington, MO
National Provider Identifier
1962501098
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- FARMINGTON CLINIC COMPANY LLC
- Practice address
- 751 Maple Valley Dr
Farmington, MO 63640-1944 - Phone
- (573) 756-1800
- Fax
- (573) 756-4476
- NPI assigned
- Sep 22, 2006
- 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
- Michael Portacci
- Title
- President
- Phone
- (615) 465-7029
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MO | Primary |
Addresses
Primary practice location
751 Maple Valley Dr
Farmington, MO 63640-1944
Mailing address
PO Box 504354
Saint Louis, MO 63150-0001
Phone (573) 756-1800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15056 | Other | MO | MEDICARE GROUP NUMBER |
Other names 1
- Maple Valley Primary Care
National Provider Directory
National Provider Directory- Part of
- Farmington Clinic Company L
Locations
603 Wallace Rd
Ste 205
Farmington, MO 63640
751 Maple Valley Dr
Farmington, MO 63640
Phone (573) 756-1800
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1962501098",
"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": "573-756-1800",
"fax_number": "573-756-4476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "751 MAPLE VALLEY DR",
"city": "FARMINGTON",
"state": "MO",
"postal_code": "636401944",
"telephone_number": "573-756-1800",
"fax_number": "573-756-4476"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FARMINGTON CLINIC COMPANY LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "FARMINGTON CLINIC COMPANY LLC",
"enumeration_date": "2006-09-22",
"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": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "MO",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP NUMBER",
"identifier": "15056",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Maple Valley Primary Care",
"code": "3",
"type": "Doing Business As"
}
]
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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.