PASSPORT HEALTH HOLDINGS, LLC (NPI# 1619518586) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619518586 |
| Entity Type | Organization |
| Organization Name | PASSPORT HEALTH HOLDINGS, LLC |
| Practice Address |
2435 Kimberly Rd Suite 140 South Bettendorf IA 52722-3509 |
| Mailing Address |
8324 E Hartford Drive Suite 200 Scottsdale AZ 85255-7801 |
| Practice Telephone | 8773588648 |
| Practice Fax Number | 8778776875 |
| Mailing Telephone | 8773588648 |
| Mailing Fax Number | 8778776875 |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2019-10-02 |
| Authorized Official Name | MR. DOUG SHACKELL (DIRECTOR OF FINANCE) |
| Authorized Official Telephone | 4806469024 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2083P0901X |
Preventive Medicine Specialization: Public Health & General Preventive Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Passport Heath | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659912533 | Passport Health Holdings, LLC | Preventive Medicine | 111 Williard Street, Suite Gc, Quincy, MA 02169-1200 | 2019-10-02 |
| 1336793843 | Passport Health Holdings, LLC | Community Health Worker | 545 Mainstream Drvie, Suite 401, Nashville, TN 37228-1231 | 2019-08-01 |
| 1093369597 | Passport Health Holdings, LLC | Community Health Worker | 901 E Saint Louis Street, Suite 107, Springfield, MO 65806-2574 | 2019-08-01 |
| 1801440318 | Passport Health Holdings, LLC | Community Health Worker | 5330 North Oak Trafficway, Suite 105, Kansas City, MO 64118-4600 | 2019-08-01 |
| 1902450406 | Passport Health Holdings, LLC | Community Health Worker | 345 Boylston Street Floor 2, Suite 202, Newton, MA 02459-2863 | 2019-08-01 |
| 1346701075 | Passport Health Holdings, LLC | Preventive Medicine | 563 W 500 South, Suite 215, Bountiful, UT 84010-8172 | 2019-03-26 |
| 1972085587 | Passport Health Holdings, LLC | Clinic/Center | 3375 E. Capital Circle Ne Bldg E, Suite 3, Tallahassee, FL 32308-3778 | 2018-08-30 |
| 1619488103 | Passport Health Holdings, LLC | Community Health Worker | 14985 W Bell Rd Bldg 12-a, Surprise, AZ 85374-3231 | 2017-10-24 |
| 1528593761 | Passport Health Holdings, LLC | Preventive Medicine | 18 Tremont Street, Suite 404, Boston, MA 02108-2304 | 2017-04-25 |
| 1578004008 | Passport Health Holdings, LLC | Preventive Medicine | 1116 E Route 66, Flagstaff, AZ 86001-4706 | 2017-03-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Massachusetts Corporations | PASSPORT HEALTH HOLDINGS, LLC | 8324 E. Hartford Dr. Ste. 200, Scottsdale, AZ 85255 |
| Street Address |
2435 KIMBERLY RD SUITE 140 |
| City | SOUTH BETTENDORF |
| State | IA |
| Zip Code | 52722-3509 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770198855 | Wellspire-bettendorf LLC | Skilled Nursing Facility | 4699 53rd Ave, Bettendorf, IA 52722 | 2020-09-15 |
| 1558873315 | Erin M Kohrt | Speech-Language Pathologist | 2500 Grant Street, Bettendorf, IA 52722 | 2017-11-01 |
| 1437680295 | Holli Christine Martin | Chiropractor | 3048 Victoria St., Bettendorf, IA 52722 | 2017-03-23 |
| 1598219552 | Alyssa Renee Matz | Counselor | 2435 Kimberly Rd Ste 96, Bettendorf, IA 52722 | 2016-08-08 |
| 1144625021 | Athletico Ltd | Physical Therapist | 3252 Ridge Point, Bettendorf, IA 52722 | 2014-11-04 |
| 1609282862 | Katherine L Browne | Nurse Practitioner | 1351 Kimberly Rd Ste 100, Bettendorf, IA 52722 | 2014-07-09 |
| 1316357494 | Kayla Leigh Ehrman | Family Medicine | 2535 Maplecrest Rd Ste 16, Bettendorf, IA 52722 | 2014-04-29 |
| 1043648454 | Duane Anthony Halbur Jr. | Counselor | 2420 Salem Ct, Bettendorf, IA 52722 | 2013-10-22 |
| 1376881185 | Christopher D Murphy | Physical Therapist | 2300 53rd Ave Ll02, Bettendorf, IA 52722 | 2013-01-29 |
| 1326386574 | Kelly C Harry | Occupational Therapist | 3470 Utica Ridge Road, Suite 4, Bettendorf, IA 52722 | 2013-01-23 |
| Find all providers in zip 52722 | ||||
| Taxonomy Code | 2083P0901X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Public Health & General Preventive Medicine |
| Public health and general preventive medicine focuses on promoting health, preventing disease, and managing the health of communities and defined populations. These practitioners combine population-based public health skills with knowledge of primary, secondary, and tertiary prevention-oriented clinical practice in a wide variety of settings. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Preventive Medicine, 2007. http://www.abprevmed.org/. American Osteopathic Board of Preventive Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871933812 | Carolyn Louise Beverly | Preventive Medicine | 3024 Deep Woods Ct, Des Moines, IA 50320-2818 | 2013-07-03 |
| 1063770576 | Caitlin Siobhan Pedati | Preventive Medicine | 321 E 12th St Fl 5, Des Moines, IA 50319-1002 | 2012-05-03 |
| 1265755631 | Robert H. Schneider | Preventive Medicine | 2100 Mansion Drive, Suite 211 - Inmp, Maharishi Vedic City, IA 52556 | 2010-03-12 |
| 1962644559 | M. Patricia Quinlisk | Preventive Medicine | 321 E 12th St, Lucas State Office Building, Des Moines, IA 50319-1002 | 2009-03-30 |
| 1588833990 | Phuong D Nguyen | Preventive Medicine | 103 62nd Street, West Des Moines, IA 50266-5842 | 2008-02-29 |
| 1093108201 | Wright County | Preventive Medicine | 115 1st St Se, Clarion, IA 50525-1401 | 2015-03-12 |
| 1366871550 | Passport Health Holdings LLC | Preventive Medicine | 950 Office Park Rd, Ste 200b, West Des Moines, IA 50265-2548 | 2013-11-07 |
| 1598725863 | Charles Ross Buck | Preventive Medicine | 540 E Jefferson St, Suite 205, Iowa City, IA 52245-2479 | 2006-03-23 |
| 1922077064 | Mahaska County Hospital | Preventive Medicine | 1229 C Ave E, Oskaloosa, IA 52577-4298 | 2006-03-14 |
| City | SOUTH BETTENDORF |
| Zip Code | 52722 |
Please comment or provide details below to improve the information on PASSPORT HEALTH HOLDINGS, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.