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PASSPORT HEALTH HOLDINGS, LLC

Physicians Preventive Medicine Public Health & General Preventive Medicine

Provider NPI: 1992121024

Organization Information:
Organization Name:  PASSPORT HEALTH HOLDINGS, LLC
Organization is not Subpart
Authorized Official:  DOUG  SHACKELL  DIRECTOR OF FINANCE  480-646-9024

Practice Location:
500 WEST CUMMINGS PARK SUITE 2475 WOBURN, MA 01801-5536 US
Tel: 877-358-8648  Fax: 877-877-8675

Business Mailing Address:
8324 E HARTFORD DR #200 SCOTTSDALE, AZ 85255 US
Tel: 888-909-6551  Fax: 480-383-6567

NPI Information:
NPI: 1992121024
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y2083P0901XPhysicians
Preventive Medicine
Public Health & General Preventive Medicine
MA261Q0000X

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 2083P0901X

Type:

Classification:



Definition:



MEDICAL JOBS MA - Page 1

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