| Organization Name: | EASTPORT HEALTH CARE, INC. MACHIAS OFFICE |
| NPI Number: | 1366559890 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES WELLMAN (CEO) |
| Mailing Address: | 12 E Main St Machias |
| State: | ME US |
| Postal Code: | 046541205 |
| Phone Number: | 2072553400 |
| Fax Number: | 2072553401 |
| NPI Enumeration Date: | 08/23/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | LC1138 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ME |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |