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Organization
PROVIDENCE HEALTH SERVICES, INC
Active
Organization
PROVIDENCE HEALTH SERVICES, INC
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. BEAU HIGGINBOTHAM (VICE PRESIDENT/COO)
(410) 638-3162
Entity
Organization
Contact information
Practice address
128 M ST NW, WASHINGTON, DC 20001-1205
(202) 682-3840
(202) 682-3854
Mailing address
1150 VARNUM ST NE RM 407, WASHINGTON, DC 20017-2180
(202) 854-4069
(202) 854-7825
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023435102
—
DC
Enumeration date
12/09/2011
Last updated
02/06/2020
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