Organization
PASSPORT HEALTH
Active
Organization
PASSPORT HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LTANYA GARRISON (PRESIDENT)
(314) 997-8100
Entity
Organization
Contact information
Practice address
2025 S BRENTWOOD BLVD, SUITE 101, SAINT LOUIS, MO 63144-1833
(314) 997-8100
(314) 997-8102
Mailing address
2025 S BRENTWOOD BLVD, SUITE 101, SAINT LOUIS, MO 63144-1833
(314) 997-8100
(314) 997-8102
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
04/07/2014
Last updated
10/02/2014
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