Organization
PROVIDENCE HEALTH SERVICES, INC
Active
Parent organization
PROVIDENCE HOSPITAL
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 312, WASHINGTON, DC 20017-2107
(202) 534-4400
(202) 435-4412
Mailing address
PO BOX 418893, BOSTON, MA 02241-8893
(202) 448-4069
(202) 269-7825
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
HFD01-0212
DC
282N00000X
General Acute Care Hospital
HFD01-0212
DC
Other
Enumeration date
11/27/2013
Last updated
10/09/2017
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