Healthcare Provider Details

I. General information

NPI: 1568757946
Provider Name (Legal Business Name): EASTPORT HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PALMER ST
CALAIS ME
04619-1386
US

IV. Provider business mailing address

PO BOX H
EASTPORT ME
04631-0909
US

V. Phone/Fax

Practice location:
  • Phone: 207-255-3400
  • Fax: 207-255-3401
Mailing address:
  • Phone: 207-853-6001
  • Fax: 207-853-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: HOLLY M GARTMAYER
Title or Position: CEO
Credential:
Phone: 207-853-6001