Passport Health

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

PASSPORT HEALTH

Practice address

2025 S Brentwood Blvd
Suite 101
Saint Louis, MO 63144-1833

Phone

(314) 997-8100

Fax

(314) 997-8102

NPI assigned

Apr 7, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ltanya Garrison

Title

President

Phone

(314) 997-8100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412208000000",
    "number": "1205255247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 S BRENTWOOD BLVD",
            "address_2": "SUITE 101",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631441833",
            "telephone_number": "314-997-8100",
            "fax_number": "314-997-8102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 S BRENTWOOD BLVD",
            "address_2": "SUITE 101",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631441833",
            "telephone_number": "314-997-8100",
            "fax_number": "314-997-8102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSPORT HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-07",
        "last_updated": "2014-10-02",
        "status": "A",
        "authorized_official_last_name": "GARRISON",
        "authorized_official_first_name": "LTANYA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-997-8100"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Passages Hospice of Missouri, LLC
• Cia Passig, OT
• Passion Adult Daycare LLC
• Passionate Care, LLC
• Passionate Health LLC
• Passport Health Holdings, LLC
• Passport Health Holdings, LLC
• Mary R Pastor, LPC
• Tamara Pastor
• Alicia Pastore

• Health Service Clinic/Center in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Health Service Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.