| NPI | 1164477568 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLEEN L ELIAS CEO/CFO 207-513-3897 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207R00000X Internal Medicine | |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
| 207RG0300X Internal Medicine, Geriatric Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2020-10-22 |