Organization
PHS INTERNAL MEDICINE DP311
Active
Organization
PHS INTERNAL MEDICINE DP311
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 (VICE PRESIDENT/COO)
(410) 368-3162
Entity
Organization
Contact information
Practice address
1160 VARNUM ST NE, DEPAUL 311, WASHINGTON, DC 20017-2107
(202) 854-4470
(202) 854-4471
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
207R00000X
Internal Medicine Physician
Primary
HFD01-0212
DC
Other
Enumeration date
09/09/2015
Last updated
10/10/2017
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