NPIMap

Organization Active NPI

Passport Health Holdings LLC

  • Clinic/Center
  • West Columbia, SC
National Provider Identifier
1609206564
Registry record updated Jul 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PASSPORT HEALTH HOLDINGS LLC
Practice address
2318-B Sunset Blvd
West Columbia, SC 29169-4716
Phone
(877) 358-8648
Fax
(877) 877-6875
NPI assigned
Nov 13, 2013
Last updated
Jul 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 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 2

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

Addresses

Primary practice location

2318-B Sunset Blvd
West Columbia, SC 29169-4716

Mailing address

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

Other names 1

  • PPH Ohio LLC Former legal business 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 6

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

Locations

2318B Sunset Blvd
West Columbia, SC 29169

NPI Registry JSON

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

{
    "created_epoch": "1384300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468281600000",
    "number": "1609206564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8324 E HARTFORD DR",
            "address_2": "SUITE 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": "2318-B SUNSET BLVD",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291694716",
            "telephone_number": "877-358-8648",
            "fax_number": "877-877-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSPORT HEALTH HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-13",
        "last_updated": "2016-07-12",
        "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": "SC",
            "license": null,
            "primary": true
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PPH Ohio LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in West Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.