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Organization
PHS MEDICAL SPECIALISTS PMB107
Active
Organization
PHS MEDICAL SPECIALISTS PMB107
Active
Parent organization
PROVIDENCE HOSPITAL
Other names
Providence Health Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HOSPITAL
Authorized official
MR. CHARLES F HABERKERN (VP)
(202) 854-4255
Entity
Organization
Contact information
Practice address
1140 VARNUM ST NE, PMB107, WASHINGTON, DC 20017-2151
(202) 854-4052
(202) 854-4832
Mailing address
1160 VARNUM ST NE, ST CATHERINE'S HALL, ROOM 102, WASHINGTON, DC 20017-2107
(202) 854-4069
(202) 854-7825
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
HFD01-0212
DC
282N00000X
General Acute Care Hospital
HFD01-0212
DC
Other
Enumeration date
03/21/2013
Last updated
09/06/2016
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