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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