Organization
PASSPORT HEALTH HOLDINGS LLC
Active
Other names
PPH Ohio LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUG SHACKELL (DIRECTOR OF FINANCE)
(480) 646-9024
Entity
Organization
Contact information
Practice address
2318-B SUNSET BLVD, WEST COLUMBIA, SC 29169-4716
(877) 358-8648
(877) 877-6875
Mailing address
8324 E HARTFORD DR, SUITE 200, SCOTTSDALE, AZ 85255-5466
(877) 358-8648
(877) 877-6875
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
SC
Other
Enumeration date
11/13/2013
Last updated
07/12/2016
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