NPI Code Detail JSON Logo

1972085587 NPI number — PASSPORT HEALTH HOLDINGS, LLC

NPI Number: 1972085587
Health Care Provider/Practitioner: PASSPORT HEALTH HOLDINGS, LLC

Information about “1972085587” NPI (PASSPORT HEALTH HOLDINGS, LLC) exists in 1972085587 in HTML format HTML  |  1972085587 in plain Text format TXT  |  1972085587 in PDF (Portable Document Format) PDF  |  1972085587 in an XML format XML  formats.

NPI Number : 1972085587 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972085587",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PASSPORT HEALTH HOLDINGS, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8324 E HARTFORD DRIVE",
    "SecondLineMailingAddress": "SUITE 200",
    "MailingAddressCityName": "SCOTTSDALE",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85255-7801",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "877-358-8648",
    "MailingAddressFaxNumber": "877-877-6875",
    "FirstLinePracticeLocationAddress": "3375 E. CAPITAL CIRCLE NE BLDG E",
    "SecondLinePracticeLocationAddress": "SUITE 3",
    "PracticeLocationAddressCityName": "TALLAHASSEE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32308-3778",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "877-358-8648",
    "PracticeLocationAddressFaxNumber": "877-877-6875",
    "EnumerationDate": "08/30/2018",
    "LastUpdateDate": "07/30/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SHACKELL",
    "AuthorizedOfficialFirstName": "DOUG",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "DIRECTOR OF FINANCE",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "480-646-9024",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261Q00000X",
          "TaxonomyName": "Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2083P0901X",
          "TaxonomyName": "Public Health & General Preventive Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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