# PROVIDENCE HEALTH SERVICES INC

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

## Provider details

- **NPI number:** 1669453809
- **Legal business name:** PROVIDENCE HOSPITAL
- **Authorized official:** MR. MITCHELL LOMAX (VICE PRESIDENT/CFO)
- **Authorized official phone:** (667) 234-2926

## Contact information

- **Practice address:** 1160 VARNUM ST NE, WASHINGTON, DC 20017-2107
- **Practice address phone:** (202) 854-7000
- **Practice address fax:** (202) 269-7160
- **Mailing address:** 1150 VARNUM ST NE, ADMINISTRATION 4TH FLOOR, WASHINGTON, DC 20017-2149
- **Mailing address phone:** (202) 854-4255
- **Mailing address fax:** (202) 854-7160

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TH0100X | Health Service Psychologist | — | NULL | — |
| 103TH0100X | Health Service Psychologist | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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

- **Enumeration date:** 11/06/2005
- **Last updated:** 11/01/2023

## 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 |