PROVIDENCE HEALTH SERVICES INC NPI 1609031632

NPI Information

NPI: 1609031632
Provider Name: PROVIDENCE HEALTH SERVICES, INC

Doing Business As: PHS OUTPATIENT BEHAVIORAL HEALTH

Classification: Psychiatry & Neurology - 2084N0400X
Entity Type: Organization

Specialization: Neurology

Address:
1140 VARNUM ST NE STE 100
WASHINGTON, DC
ZIP 20017
Phone: (202) 854-7623
Get Directions

PROVIDENCE HEALTH SERVICES, INC is a neurology psychiatry neurology in Washington, DC. The provider is a Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. PROVIDENCE HEALTH SERVICES, INC NPI is 1609031632. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Phs Outpatient Behavioral Health.

The provider's business location address is:

1140 VARNUM ST NE STE 100
WASHINGTON, DC
ZIP 20017
Phone: (202) 854-7623
Fax: (202) 854-7616

The provider's authorized official is Mitchell Lomax .
The authorized official title is Vice President/cfo and has the following contact phone number (667) 234-2926.

The enumeration date for this NPI number is 7/18/2008 and was last updated on 10/20/2023.

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	103T00000X	Psychologist		HFD01-0212	DISTRICT OF COLUMBIA	No
2	104100000X	Social Worker		HFD01-0212	DISTRICT OF COLUMBIA	No
3	2084A0401X	Psychiatry & Neurology	Addiction Medicine	HFD01-0212	DISTRICT OF COLUMBIA	No
4	2084B0040X	Psychiatry & Neurology	Behavioral Neurology & Neuropsychiatry	HFD01-0212	DISTRICT OF COLUMBIA	No
5	101Y00000X	Counselor		HFD01-0212	DISTRICT OF COLUMBIA	No
6	2084N0400X	Psychiatry & Neurology	Neurology	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	Other Provider Identifier Issuer
1	985415100	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: 4/28/2024

NPI Synchronization or Removal

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