Basic Information
| Provider Information | |||||||||
| NPI: | 1538199112 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FARMINGTON MISSOURI HOSPITAL COMPANY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1212 WEBER ROAD | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737564581 | ||||||||
| FaxNumber: | 5737565834 | ||||||||
| Practice Location | |||||||||
| Address1: | 1212 WEBER ROAD | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737564581 | ||||||||
| FaxNumber: | 5737565834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PORTACCI | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6154657000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 2047951132 | 01 | MO | TAX ID | OTHER |