NPIMap

Organization Active NPI

Passport Health Holdings, LLC

  • Public Health & General Preventive Medicine Physician
  • Provo, UT
National Provider Identifier
1205377736
Registry record updated Mar 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X
Legal business name
PASSPORT HEALTH HOLDINGS, LLC
Practice address
1055 North 300 West
Ste 416
Provo, UT 84604-3354
Phone
(877) 358-8648
Fax
(877) 877-6875
NPI assigned
Mar 16, 2017
Last updated
Mar 16, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2017

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

Authorized official

Name
Mr. Doug Shackell
Title
Director of Finance
Phone
(480) 646-9024

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health & General Preventive Medicine Physician 2083P0901X NU Primary

Addresses

Primary practice location

1055 North 300 West
Ste 416
Provo, UT 84604-3354

Mailing address

8324 E Hartford Dr
Ste 200
Scottsdale, AZ 85255-7801
Phone (877) 358-8648

Other names 1

  • PPH Franchise Holdings, LLC Other name

National Provider Directory

National Provider Directory
Tax ID family
Passport Health Holdings LLC219 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 3

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

NPI Registry JSON

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

{
    "created_epoch": "1489622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489622400000",
    "number": "1205377736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8324 E HARTFORD DR",
            "address_2": "STE 200",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852557801",
            "telephone_number": "877-358-8648",
            "fax_number": "877-877-6875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 NORTH 300 WEST",
            "address_2": "STE 416",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043354",
            "telephone_number": "877-358-8648",
            "fax_number": "877-877-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSPORT HEALTH HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-16",
        "last_updated": "2017-03-16",
        "status": "A",
        "authorized_official_last_name": "SHACKELL",
        "authorized_official_first_name": "DOUG",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "480-646-9024",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PPH Franchise Holdings, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.