Organization
PHS CARE CENTER
Active
Parent organization
PROVIDENCE HOSPITAL
Other names
Providence Health Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HOSPITAL
Authorized official
BEAU HIGGINBOTHAM (VP)
(410) 368-3168
Entity
Organization
Contact information
Practice address
1150 VARNUM ST NE, SUITE 201, WASHINGTON, DC 20017-2104
(202) 854-7674
(202) 269-7825
Mailing address
1160 VARNUM ST NE, ST CATHERINE'S HALL, ROOM 102, WASHINGTON, DC 20017-2107
(202) 854-4069
(202) 854-7825
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
363L00000X
Nurse Practitioner
Primary
HFD01-0212
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023435100
—
DC
05
—
025501700
—
MD
Enumeration date
07/11/2008
Last updated
06/07/2017
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