Organization
PASSPORT HEALTH HOLDINGS, LLC
Active
Other names
Passport Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUG SHACKELL (DIRECTOR OF FINANCE)
(480) 646-9024
Entity
Organization
Contact information
Practice address
901 E SAINT LOUIS STREET, SUITE 107, SPRINGFIELD, MO 65806-2574
(877) 358-8648
(877) 877-6875
Mailing address
8324 E HARTFORD DR., SUITE 200, SCOTTSDALE, AZ 85255-7801
(877) 358-8648
(877) 877-6875
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
08/01/2019
Last updated
08/01/2019
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