Organization
PROVIDENCE HEALTH SERVICES
Active
Parent organization
PROVIDENCE HOSPITAL
Other names
PHS General Surgery 104
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 104, WASHINGTON, DC 20017-2107
(202) 854-4440
(202) 854-4430
Mailing address
1160 VARNUM ST NE, ST CATHERINE'S HALL ROOM 102, WASHINGTON, DC 20017-2107
(202) 854-4440
(202) 854-4430
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
HFD01-0212
DC
Other
Enumeration date
07/11/2008
Last updated
10/09/2017
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