| NPI | 1902194426 |
|---|---|
| Doing Business As | PASSPORT HEALTH TRIAD |
| Entity Type | Organization |
| Authorized Contact | AMY CAROLINE SAPP Medical Director 336-768-0717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2011-07-18 |