NPIMap

Organization Active NPI

Passport Health Holdings LLC

  • Public Health & General Preventive Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1376033233
Registry record updated May 16, 2018
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
4647 N 32ND Street
Suite 115 1St Floor
Phoenix, AZ 85018-3346
Phone
(877) 358-8648
Fax
(877) 877-6875
NPI assigned
May 16, 2018
Last updated
May 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2018

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2083P0901X Primary

Addresses

Primary practice location

4647 N 32ND Street
Suite 115 1St Floor
Phoenix, AZ 85018-3346

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 12

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

Locations

4647 N 32nd St
Ste 115
Phoenix, AZ 85018

NPI Registry JSON

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

{
    "created_epoch": "1526428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526428800000",
    "number": "1376033233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8324 E HARTFORD DR 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": "4647 N 32ND STREET",
            "address_2": "SUITE 115 1ST FLOOR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850183346",
            "telephone_number": "877-358-8648",
            "fax_number": "877-877-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSPORT HEALTH HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-16",
        "last_updated": "2018-05-16",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PPH Franchise Holdings LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2018; 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.