Organization
PROVIDENCE HEALTH SERVICES, INC
Active
Parent organization
PROVIDENCE HOSPITAL
Other names
PHS Unity Healthcare Parkside Radiology
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HOSPITAL
Authorized official
BEAU HIGGINBOTHAN (VICE PRESIDENT/COO)
(410) 368-3162
Entity
Organization
Contact information
Practice address
765 KENILWORTH TER NE, WASHINGTON, DC 20019-1898
(202) 299-1796
(202) 388-8164
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
261QR0200X
Radiology Clinic/Center
Primary
HFD01-0212
DC
Other
Enumeration date
10/17/2017
Last updated
10/17/2017
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