Organization
PASSPORT HEALTH HOLDINGS, LLC
Active
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
3375 E. CAPITAL CIRCLE NE BLDG E, SUITE 3, TALLAHASSEE, FL 32308-3778
(877) 358-8648
(877) 877-6875
Mailing address
8324 E HARTFORD DRIVE, SUITE 200, SCOTTSDALE, AZ 85255-7801
(877) 358-8648
(877) 877-6875
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
08/30/2018
Last updated
07/30/2019
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