# PROVIDENCE HEALTH SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE HOSPITAL
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1194985515
- **Legal business name:** PROVIDENCE HOSPITAL
- **Authorized official:** TIMOTHY SHERIDAN (ASSISTANT VP, PRACTICE MGT SERVICES)
- **Authorized official phone:** (202) 269-7374

## Contact information

- **Practice address:** 4151 BLADENSBURG RD, COLMAR MANOR, MD 20722-1928
- **Practice address phone:** (301) 699-7700
- **Practice address fax:** (301) 779-9001
- **Mailing address:** 1150 VARNUM ST NE, WASHINGTON, DC 20017-2149
- **Mailing address phone:** (202) 269-7286
- **Mailing address fax:** (202) 269-7825

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | HFD01-0212 | DC | Yes |
| 207R00000X | Internal Medicine Physician | HFD01-0212 | DC | — |

## Other

- **Enumeration date:** 06/10/2008
- **Last updated:** 10/09/2017