Passport Health Holdings, LLC

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

Legal business name

PASSPORT HEALTH HOLDINGS, LLC

Doing business as

Passport Health

Practice address

22 Monument Square
Suite 507
Portland, ME 04101-4031

Phone

(877) 358-8648

Fax

(877) 877-6875

NPI assigned

Oct 2, 2019

Organization subpart

No

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

Authorized official

Name

Mr. Dough Shackell

Title

Director of Finance

Phone

(480) 646-9024

Specialties & licenses 1

Addresses

Other names 1

• Passport Health Doing business as

Tax ID family

Passport Health Holdings LLC218 organizations share this tax ID, including this one

Locations

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

{
    "created_epoch": "1569974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569974400000",
    "number": "1245871110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8324 E HARTFORD DRIVE",
            "address_2": "SUITE 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": "22 MONUMENT SQUARE",
            "address_2": "SUITE 507",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041014031",
            "telephone_number": "877-358-8648",
            "fax_number": "877-877-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSPORT HEALTH HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-02",
        "last_updated": "2019-10-02",
        "status": "A",
        "authorized_official_last_name": "SHACKELL",
        "authorized_official_first_name": "DOUGH",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Passport Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lexi Parsons, LCPC
• Lisa J Parsons, DO
• Matthew Willis Parsons, MD
• Amy Partridge-Barber, LCSW
• Susan Elizabeth Partridge, MSW, PH.D.
• Paul Harvey Pasternack, D.M.D.
• Alexandra Catherine Pastore, APRN-AGACNP
• David Alan Patch Jr., LCPC
• Karishma Hitesh Patel, DO
• Shivani Patel, MD

• Public Health & General Preventive Medicine Physician in Portland, ME
• Providers in Portland, ME by specialty
• Public Health & General Preventive Medicine Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2019; 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.