Passport Health Holdings, LLC

NPI #1245871110 in Portland, Maine

Provider Information

NPI Number: 1245871110
Entity Type: Organization
Organization Name: Passport Health Holdings, LLC
Primary Specialty: Preventive Medicine - Public Health & General Preventive Medicine
Enumeration Date: Oct 2, 2019
Last Updated: Oct 2, 2019

Practice Location

Address: 22 MONUMENT SQUARE
Address 2: SUITE 507
City: Portland
State: Maine
ZIP Code: 04101-4031
Phone: (877) 358-8648

Authorized Official

Name: MR. DOUGH SHACKELL
Title: DIRECTOR OF FINANCE
Phone: (480) 646-9024

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Preventive Medicine - Public Health & General Preventive Medicine — Public Health & General Preventive Medicine	2083P0901X	Primary

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