NPIMap

Organization Active NPI

Passport Health Holdings LLC

  • Clinic/Center
  • Sterling, VA
National Provider Identifier
1336579226
Registry record updated Jul 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PASSPORT HEALTH HOLDINGS LLC
Practice address
1402 Shepard Dr
Ste 101
Sterling, VA 20164-4425
Phone
(877) 358-8648
Fax
(877) 877-6875
NPI assigned
Nov 14, 2013
Last updated
Jul 11, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2016

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X VA
Clinic/Center 261Q00000X NU Primary
Public Health & General Preventive Medicine Physician 2083P0901X NU

Addresses

Primary practice location

1402 Shepard Dr
Ste 101
Sterling, VA 20164-4425

Mailing address

8324 E Hartford Dr
Ste 200
Scottsdale, AZ 85255-5466
Phone (877) 358-8648

Other names 1

  • PPH Global Services 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 16

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

View all 16

Locations

1402 Shepard Dr
Ste 101
Sterling, VA 20164

NPI Registry JSON

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

{
    "created_epoch": "1384387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468195200000",
    "number": "1336579226",
    "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": "852555466",
            "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": "1402 SHEPARD DR",
            "address_2": "STE 101",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201644425",
            "telephone_number": "877-358-8648",
            "fax_number": "877-877-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSPORT HEALTH HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-14",
        "last_updated": "2016-07-11",
        "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": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "VA",
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PPH Global Services LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sterling, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2016; 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.