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Organization

PROVIDENCE HEALTH SERVICES, INC

Active
Parent organization
PROVIDENCE HOSPITAL
Other names
PHS Cardiology
Organization subpart
Yes

Provider details

NPI number
Legal business name
PROVIDENCE HOSPITAL
Authorized official
BEAU HIGGINBOTHAN (VICE PRESIDENT/COO)
(410) 368-3182
Entity
Organization

Contact information

Practice address
1150 VARNUM ST NE STE 300, WASHINGTON, DC 20017-2180
(202) 854-4830
(202) 854-4836
Mailing address
1150 VARNUM ST NE, ST CATHERINES HALL, ROOM 102, WASHINGTON, DC 20017-2104
(202) 854-4069
(202) 854-7825

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
HFD01-0212
DC
207RC0000X
Cardiovascular Disease Physician
Primary
HFD01-0212
DC

Other

Enumeration date
01/12/2018
Last updated
01/12/2018
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