Organization
PROVIDENCE HEALTH SERVICES, INC
Active
Parent organization
PROVIDENCE HOSPITAL
Other names
PHS Otolaryngology PMB200
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
1140 VARNUM ST NE, PMB 200, WASHINGTON, DC 20017-2151
(202) 854-4355
(202) 854-4398
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
207Y00000X
Otolaryngology Physician
Primary
HFD01-0212
DC
282N00000X
General Acute Care Hospital
HFD01-0212
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
548521500
—
MD
Enumeration date
12/13/2011
Last updated
02/01/2018
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