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Organization
PROVIDENCE HEALTH SERVICES INC
Active
Organization
PROVIDENCE HEALTH SERVICES INC
Active
Parent organization
PROVIDENCE HOSPITAL
Other names
Providence Hospital
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HOSPITAL
Authorized official
MR. MITCHELL LOMAX (VICE PRESIDENT/CFO)
(667) 234-2926
Entity
Organization
Contact information
Practice address
1160 VARNUM ST NE, WASHINGTON, DC 20017-2107
(202) 854-7000
(202) 269-7160
Mailing address
1150 VARNUM ST NE, ADMINISTRATION 4TH FLOOR, WASHINGTON, DC 20017-2149
(202) 854-4255
(202) 854-7160
Taxonomy
Speciality
Code
Description
License number
State
103TH0100X
Health Service Psychologist
—
NULL
103TH0100X
Health Service Psychologist
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
208M00000X
Hospitalist Physician
—
NULL
208M00000X
Hospitalist Physician
—
—
251B00000X
Case Management Agency
HFD01-0212
DC
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023435100
—
DC
05
—
023435101
—
MD
05
—
023435102
—
DC
05
—
080352200
—
DC
05
—
5485215 00
—
DC
05
—
5485215 01
—
MD
Enumeration date
11/06/2005
Last updated
11/01/2023
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