# PHS MEDICAL SPECIALISTS PMB107

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE HOSPITAL
- **Other names:** Providence Health Services
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1457693012
- **Legal business name:** PROVIDENCE HOSPITAL
- **Authorized official:** MR. CHARLES F HABERKERN (VP)
- **Authorized official phone:** (202) 854-4255

## Contact information

- **Practice address:** 1140 VARNUM ST NE, PMB107, WASHINGTON, DC 20017-2151
- **Practice address phone:** (202) 854-4052
- **Practice address fax:** (202) 854-4832
- **Mailing address:** 1160 VARNUM ST NE, ST CATHERINE'S HALL, ROOM 102, WASHINGTON, DC 20017-2107
- **Mailing address phone:** (202) 854-4069
- **Mailing address fax:** (202) 854-7825

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0200X | Infectious Disease Physician | HFD01-0212 | DC | Yes |
| 282N00000X | General Acute Care Hospital | HFD01-0212 | DC | — |

## Other

- **Enumeration date:** 03/21/2013
- **Last updated:** 09/06/2016