Organization
PHS GENERAL SURGRY DP318
Active
Parent organization
PROVIDENCE HOSPITAL
Other names
Providence Health Services, Inc
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HOSPITAL
Authorized official
MR. GREGORY ZIEGLER (AVP FINANCE)
(202) 854-7284
Entity
Organization
Contact information
Practice address
1160 VARNUM ST NE, DEPAUL 318, WASHINGTON, DC 20017-2107
(202) 854-4014
(301) 262-8291
Mailing address
1150 VARNUM ST NE, ST CATHERINE'S HALL, ROOM 102, WASHINGTON, DC 20017-2104
(202) 854-4014
(301) 262-8291
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
HFD01-0212
DC
282N00000X
General Acute Care Hospital
HFD01-0212
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005145400
—
MD
05
—
029833400
—
DC
05
—
09810714
—
VA
Enumeration date
07/10/2012
Last updated
09/06/2016
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