Organization
PHS GEN SURG DP306
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 (PRESIDENT/COO)
(410) 368-3162
Entity
Organization
Contact information
Practice address
1160 VARNUM ST NE, DEPAUL 306, WASHINGTON, DC 20017-2107
(202) 854-4069
(202) 854-7825
Mailing address
1160 VARNUM ST NE, ST CATHERINES'S HALL, ROOM 102, WASHINGTON, DC 20017-2107
(202) 854-4069
(202) 854-7825
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
HFD01-0212
DC
Other
Enumeration date
05/26/2015
Last updated
10/09/2017
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