| Maple Valley Primary Care | |
|
751 Maple Valley Dr Farmington MO 63640-1944 | |
| (573) 756-1800 | |
| (573) 756-4476 |
| Full Name | Maple Valley Primary Care |
|---|---|
| Speciality | Family Medicine |
| Location | 751 Maple Valley Dr, Farmington, Missouri |
| Authorized Official Name and Position | Michael Portacci (PRESIDENT) |
| Authorized Official Contact | 6154657029 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maple Valley Primary Care Po Box 504354 Saint Louis MO 63150-0001 Ph: (573) 756-1800 | Maple Valley Primary Care 751 Maple Valley Dr Farmington MO 63640-1944 Ph: (573) 756-1800 |
| NPI Number | 1962501098 |
|---|---|
| Provider Enumeration Date | 09/22/2006 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962501098 | NPI | - | NPPES |
| 15056 | Other | MO | MEDICARE GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Missouri) | Primary |
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