# PASSPORT HEALTH HOLDINGS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Passport Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972085587
- **Authorized official:** MR. DOUG SHACKELL (DIRECTOR OF FINANCE)
- **Authorized official phone:** (480) 646-9024

## Contact information

- **Practice address:** 3375 E. CAPITAL CIRCLE NE BLDG E, SUITE 3, TALLAHASSEE, FL 32308-3778
- **Practice address phone:** (877) 358-8648
- **Practice address fax:** (877) 877-6875
- **Mailing address:** 8324 E HARTFORD DRIVE, SUITE 200, SCOTTSDALE, AZ 85255-7801
- **Mailing address phone:** (877) 358-8648
- **Mailing address fax:** (877) 877-6875

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | NULL | Yes |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/30/2018
- **Last updated:** 07/30/2019