Provider Demographics
NPI:1316041569
Name:NORTHPORT MEDICAL CLINIC PLC
Entity Type:Organization
Organization Name:NORTHPORT MEDICAL CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:EICHENLAMB
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:231-386-5450
Mailing Address - Street 1:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49670
Mailing Address - Country:US
Mailing Address - Phone:231-386-5450
Mailing Address - Fax:231-386-7192
Practice Address - Street 1:301 MILL STREET
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:MI
Practice Address - Zip Code:49670
Practice Address - Country:US
Practice Address - Phone:231-386-5450
Practice Address - Fax:231-386-7192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-09
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center