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General NPI Number Information
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NPI Number | 1093752917
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Entity Type | Organization
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Legal Business Name | EASTPORT HEALTH CARE, INC.
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 30 BOYNTON ST
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City | EASTPORT
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State | ME
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Zip | 04631-1306
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Country | US
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Telephone | 207-853-6001
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Fax | 207-853-4028
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Provider Business Mailing Address
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Address Line | PO BOX H
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City | EASTPORT
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State | ME
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Zip | 04631-0909
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Country | US
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Telephone | 207-853-6001
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Fax | 207-853-4028
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. ELLEN KRAJEWSKI
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Credential |
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Telephone | 207-853-6001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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