Healthcare Provider Details

I. General information

NPI: 1376097980
Provider Name (Legal Business Name): PASSPORT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 MILL ST STE 301
RENO NV
89502-1436
US

IV. Provider business mailing address

890 MILL ST STE 301
RENO NV
89502-1436
US

V. Phone/Fax

Practice location:
  • Phone: 888-909-6551
  • Fax: 877-877-6875
Mailing address:
  • Phone: 888-909-6551
  • Fax: 877-877-6875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MELANIE FRENCH
Title or Position: VP CLINIC OPERATIONS
Credential:
Phone: 888-909-6551