Organization
PASSPORT HEALTH HOLDINGS, LLC
Active
Other names
Passport Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL FISHBURN (CHIEF OPERATING OFFICER)
(480) 646-9020
Entity
Organization
Contact information
Practice address
1701 CENTER VIEW DRIVE, SUITE 324, LITTLE ROCK, AR 72211-4308
(877) 358-8648
(877) 877-6875
Mailing address
668 N 44TH ST, SUITE 100W, PHOENIX, AZ 85008-6507
(877) 358-8648
(480) 546-3421
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
261Q00000X
Clinic/Center
—
AR
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
11/07/2013
Last updated
03/25/2022
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