Provider Demographics
NPI:1376097980
Name:PASSPORT HEALTH
Entity Type:Organization
Organization Name:PASSPORT HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRENCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-909-6551
Mailing Address - Street 1:890 MILL ST STE 301
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1436
Mailing Address - Country:US
Mailing Address - Phone:888-909-6551
Mailing Address - Fax:877-877-6875
Practice Address - Street 1:890 MILL ST STE 301
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1436
Practice Address - Country:US
Practice Address - Phone:888-909-6551
Practice Address - Fax:877-877-6875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare