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PROVIDENCE HEALTH SERVICES INC NPI 1366710766


NPI Information

NPI: 1366710766
Provider Name: PROVIDENCE HEALTH SERVICES, INC

Doing Business As: PHS OTOLARYNGOLOGY PMB200

Classification: Otolaryngology - 207Y00000X
Entity Type: Organization
Address:
1140 VARNUM ST NE
PMB 200
WASHINGTON, DC
ZIP 20017
Phone: (202) 854-4355
Get Directions

PROVIDENCE HEALTH SERVICES, INC is an otolaryngology in Washington, DC. The provider is an otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. PROVIDENCE HEALTH SERVICES, INC NPI is 1366710766. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Phs Otolaryngology Pmb200.

The provider's business location address is:

1140 VARNUM ST NE
PMB 200
WASHINGTON, DC
ZIP 20017-151
Phone: (202) 854-4355
Fax: (202) 854-4398

The provider's authorized official is Beau Higginbothan .
The authorized official title is Vice President/coo and has the following contact phone number (410) 368-3182.

The enumeration date for this NPI number is 12/13/2011 and was last updated on 2/1/2018.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Y00000XOtolaryngologyHFD01-0212DISTRICT OF COLUMBIAYes
2282N00000XGeneral Acute Care HospitalHFD01-0212DISTRICT OF COLUMBIANo

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1548521500MEDICAIDMARYLAND

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: 4/28/2024

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