Provider Demographics
NPI:1861816357
Name:PASSPORT HEALTH
Entity Type:Organization
Organization Name:PASSPORT HEALTH
Other - Org Name:PPH FRANCHIS HOLDINGS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:SOWARDS
Authorized Official - Last Name:FALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-646-9029
Mailing Address - Street 1:8324 E. HARTFORD DR. #200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255
Mailing Address - Country:US
Mailing Address - Phone:480-646-9029
Mailing Address - Fax:480-383-6567
Practice Address - Street 1:8249 W 95TH ST.
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212
Practice Address - Country:US
Practice Address - Phone:888-909-6551
Practice Address - Fax:480-383-6567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health