Healthcare Provider Details

I. General information

NPI: 1306544127
Provider Name (Legal Business Name): PASSPORT HEALTH HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 06/03/2023
Certification Date: 06/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 EXTON COMMONS
EXTON PA
19341
US

IV. Provider business mailing address

4343 EAST OUTLIER BLV. SUITE 100W
PHOENIX AZ
85008-6507
US

V. Phone/Fax

Practice location:
  • Phone: 844-358-8648
  • Fax: 877-877-6875
Mailing address:
  • Phone: 844-358-8648
  • Fax: 877-877-6875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SARAH RAPIER
Title or Position: MEDICAL BILLING SPECIALIST
Credential:
Phone: 480-646-9035