PASSPORT HEALTH PC NPI 1154693695

NPI Information

PASSPORT HEALTH PC is a health service clinic center in Research Triangle Park, NC. PASSPORT HEALTH PC NPI is 1154693695. The provider is registered as an organization entity type.
The provider Is Doing Business As Passport Health Triangle.

The provider's business location address is:

100 PARK DR
SUITE 201
RESEARCH TRIANGLE PARK, NC
ZIP 27709-165
Phone: (919) 781-0053
Fax: (919) 481-0455

The provider's authorized official is Edith Bernosky .
The authorized official title is President and has the following contact phone number (919) 781-0053.

The CLIA number assigned to this NPI record is 34D2182038 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/30/2012 and was last updated on 1/30/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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