Provider Demographics
NPI:1578992772
Name:PASSPORT HEALTH HOLDINGS, LLC
Entity type:Organization
Organization Name:PASSPORT HEALTH HOLDINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-646-9035
Mailing Address - Street 1:4343 EAST OUTLIER BLV
Mailing Address - Street 2:SUITE 100W
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6507
Mailing Address - Country:US
Mailing Address - Phone:844-358-8648
Mailing Address - Fax:877-877-6875
Practice Address - Street 1:6600 FRANCE AVENUE SOUTH
Practice Address - Street 2:SUITE 410
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:844-358-8648
Practice Address - Fax:877-877-6875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 2083P0901X, 261Q00000X
MN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center