Organization
PASSPORT HEALTH HOLDINGS, LLC.
Active
Other names
PPH Ohio, LLC.
Organization subpart
No
Provider details
NPI number
Authorized official
DOUG SHACKELL (DIRECTOR OF FINANCE)
(480) 646-9024
Entity
Organization
Contact information
Practice address
29 PLANTATION PARK DR, B100 #117, BLUFFTON, SC 29910
(888) 909-6551
(480) 383-6567
Mailing address
8324 E HARTFORD DR, #200, SCOTTSDALE, AZ 85255
(888) 909-6551
(480) 383-6567
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
OH
Other
Enumeration date
03/19/2014
Last updated
03/18/2016
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