Provider Demographics
NPI:1902194426
Name:ARDMORE TRAVEL HEALTH
Entity Type:Organization
Organization Name:ARDMORE TRAVEL HEALTH
Other - Org Name:PASSPORT HEALTH TRIAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:CAROLINE
Authorized Official - Last Name:SAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-768-0717
Mailing Address - Street 1:3722 VEST MILL RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2912
Mailing Address - Country:US
Mailing Address - Phone:336-768-0717
Mailing Address - Fax:336-768-0718
Practice Address - Street 1:3722 VEST MILL RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2912
Practice Address - Country:US
Practice Address - Phone:336-768-0717
Practice Address - Fax:336-768-0718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center