# PROVIDENCE HEALTH SERVICES, INC

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

## Provider details

- **NPI number:** 1619245222
- **Legal business name:** PROVIDENCE HOSPITAL
- **Authorized official:** MR. BEAU HIGGINBOTHAM (VICE PRESIDENT/COO)
- **Authorized official phone:** (410) 638-3162

## Contact information

- **Practice address:** 128 M ST NW, WASHINGTON, DC 20001-1205
- **Practice address phone:** (202) 682-3840
- **Practice address fax:** (202) 682-3854
- **Mailing address:** 1150 VARNUM ST NE RM 407, WASHINGTON, DC 20017-2180
- **Mailing address phone:** (202) 854-4069
- **Mailing address fax:** (202) 854-7825

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/09/2011
- **Last updated:** 02/06/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 023435102 | — | DC |