Healthcare Provider Details

I. General information

NPI: 1942635362
Provider Name (Legal Business Name): PASSPORT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 E CAMELBACK RD STE 200
SCOTTSDALE AZ
85251-2031
US

IV. Provider business mailing address

6710 E CAMELBACK RD STE 200
SCOTTSDALE AZ
85251-2031
US

V. Phone/Fax

Practice location:
  • Phone: 877-358-8648
  • Fax:
Mailing address:
  • Phone: 877-358-8648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA SOWARDS
Title or Position: CLINICAL SUPERVISOR
Credential: RN
Phone: 877-358-8648