PHS FAMILY MEDICINE & PEDIATRICS PMB103 NPI 1750659272

NPI Information

NPI: 1750659272
Provider Name: PHS FAMILY MEDICINE & PEDIATRICS PMB103

Other Name: PROVIDENCE HEALTH SERVICES

Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
1140 VARNUM ST NE
PMB103
WASHINGTON, DC
ZIP 20017
Phone: (202) 854-7074
Get Directions

PHS FAMILY MEDICINE & PEDIATRICS PMB103 is a family medicine in Washington, DC. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. PHS FAMILY MEDICINE & PEDIATRICS PMB103 NPI is 1750659272. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Providence Health Services.

The provider's business location address is:

1140 VARNUM ST NE
PMB103
WASHINGTON, DC
ZIP 20017-151
Phone: (202) 854-7074
Fax: (202) 854-7470

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 enumeration date for this NPI number is 12/12/2011 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	License Number	License State	Primary
1	208000000X	Pediatrics	HFD01-0212	DISTRICT OF COLUMBIA	No
2	282N00000X	General Acute Care Hospital	HFD01-0212	DISTRICT OF COLUMBIA	No
3	207Q00000X	Family 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	09810714	MEDICAID	VIRGINIA
2	029833400	MEDICAID	DISTRICT OF COLUMBIA
3	090006	MEDICARE PIN
4	005145100	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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