Organization
PROVIDENCE HEALTH SERVICES, INC
Active
Parent organization
PROVIDENCE HOSPITAL
Other names
PHS Anesthesia
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, WASHINGTON, DC 20017-2104
(202) 854-4041
(202) 854-4034
Mailing address
1150 VARNUM ST NE, ST CATHERINES HALL, ROOM 102, 20017, DC 20017-2104
(202) 854-4069
(202) 854-7825
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
HFD01-0212
DC
367500000X
Certified Registered Nurse Anesthetist
HFD01-0212
DC
367H00000X
Anesthesiologist Assistant
HFD01-0212
DC
Other
Enumeration date
12/06/2017
Last updated
12/06/2017
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