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
118 HUXLEY RD STE 1, KNOXVILLE, TN 37922-3183
(877) 358-8648
(877) 877-8675
Mailing address
8324 E HARTFORD DR, #200, SCOTTSDALE, AZ 85255
(888) 909-6551
(480) 383-6567
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
TN
Other
Enumeration date
03/13/2014
Last updated
08/29/2018
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