Organization
PROVIDENCE HEALTH SERVICES, INC
Active
Parent organization
PROVIDENCE HOSPITAL
Other names
PHS GYN GROUP
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
1150 VARNUM ST NE, ST CATHERINE'S HALL, 2ND FLOOR, WASHINGTON, DC 20017-2107
(202) 854-7074
(202) 854-7470
Mailing address
1160 VARNUM ST NE STE 102, WASHINGTON, DC 20017-2106
(202) 854-4069
(202) 854-7825
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
HFD01-0212
DC
Other
Enumeration date
09/26/2017
Last updated
10/11/2017
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