PHS INTERNAL MEDICINE PMB202 NPI 1326316936

NPI Information

NPI: 1326316936
Provider Name: PHS INTERNAL MEDICINE PMB202
Classification: Internal Medicine - 207R00000X
Entity Type: Organization
Other Name: PROVIDENCE HEALTH SERVICES
CLIA Number: 09D2273468
Address: 1140 VARNUM ST NE
PMB 202
WASHINGTON, DC
ZIP 20017
Phone: (202) 854-4242

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NPI Details

PHS INTERNAL MEDICINE PMB202 is an internal medicine in Washington, DC. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. PHS INTERNAL MEDICINE PMB202 NPI is 1326316936. The provider is registered as an organization entity type.
The provider Other Name Is Providence Health Services.

The provider's business location address is:

1140 VARNUM ST NE
PMB 202
WASHINGTON, DC
ZIP 20017-151
Phone: (202) 854-4242
Fax: (202) 854-4245

The provider's authorized official is Charles F Haberkern .
The authorized official title is Vp and has the following contact phone number (202) 854-4255.

The CLIA number assigned to this NPI record is 09D2273468 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/9/2011 and was last updated on 9/6/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	282N00000X	General Acute Care Hospital		HFD01-0212	DISTRICT OF COLUMBIA	No
2	207R00000X	Internal Medicine		HFD01-0212	DISTRICT OF COLUMBIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	090006	MEDICARE PIN
2	09810714	MEDICAID	VIRGINIA
3	029833400	MEDICAID	DISTRICT OF COLUMBIA
4	005145400	MEDICAID	MARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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