OrganizationActive
Passport Health Holdings, LLC
NPI 1205377736 · Public Health & General Preventive Medicine Physician · Provo, UT
Provider details
- NPI number
- 1205377736
- Entity type
- Organization
- Primary specialty
- Public Health & General Preventive Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Doug Shackell, Director of Finance(480) 646-9024
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(70/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1055 North 300 West
Ste 416
Provo, UT 84604-3354
Phone: (877) 358-8648
Fax: (877) 877-6875
Street-level locationGet directions
Mailing address
8324 E Hartford Dr
Scottsdale, AZ 85255-7801
Other names (DBA / former)
- Other name
- Pph Franchise Holdings, LLC
Registry dates
- Enumerated
- 2017-03-16
- Last updated
- 2017-03-16
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.