PROVIDENCE HEALTH SERVICES, INC (NPI# 1366710766) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366710766 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH SERVICES, INC |
| Other Organization Name | PHS OTOLARYNGOLOGY PMB200 |
| Practice Address |
1140 Varnum St Ne Pmb 200 Washington DC 20017-2151 |
| Mailing Address |
1160 Varnum St Ne St Catherine's Hall, Room 102 Washington DC 20017-2107 |
| Practice Telephone | 2028544355 |
| Practice Fax Number | 2028544398 |
| Mailing Telephone | 2028544069 |
| Mailing Fax Number | 2028547825 |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2018-02-01 |
| Authorized Official Name | BEAU HIGGINBOTHAN (VICE PRESIDENT/COO) |
| Authorized Official Telephone | 4103683182 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 282N00000X | General Acute Care Hospital | HFD01-0212 | DC | Hospitals |
| Y | 207Y00000X | Otolaryngology | HFD01-0212 | DC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 548521500 | 05 |
| Other Name | Type Code |
|---|---|
| PHS Otolaryngology PMB200 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356859334 | Providence Health Services, Inc | Specialist | 1150 Varnum St Ne Ste 300, Washington, DC 20017-2180 | 2018-01-12 |
| 1609031632 | Providence Health Services, Inc | Psychiatry & Neurology | 1140 Varnum St Ne Ste 100, Washington, DC 20017 | 2008-07-18 |
| 1598313595 | Providence Health Services, Inc | Clinic/Center | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2019-09-03 |
| 1740795293 | Providence Health Services, Inc | Nurse Anesthetist, Certified Registered | 1150 Varnum St Ne, Washington, DC 20017-2104 | 2017-12-06 |
| 1679087365 | Providence Health Services, Inc | Clinic/Center | 1150 Varnum St Ne, Washington, DC 20017-2104 | 2017-11-17 |
| 1730690801 | Providence Health Services, Inc | Clinic/Center | 765 Kenilworth Ter Ne, Washington, DC 20019-1898 | 2017-10-17 |
| 1972012615 | Providence Health Services, Inc | Obstetrics & Gynecology | 1150 Varnum St Ne, St Catherine's Hall, 2nd Floor, Washington, DC 20017-2107 | 2017-09-26 |
| 1689005720 | Providence Health Services, Inc | General Acute Care Hospital | 1160 Varnum St Ne, Depaul 312, Washington, DC 20017-2107 | 2013-11-27 |
| 1619245222 | Providence Health Services, Inc | Family Medicine | 128 M St Nw, Washington, DC 20001-1205 | 2011-12-09 |
| Street Address |
1140 VARNUM ST NE PMB 200 |
| City | WASHINGTON |
| State | DC |
| Zip Code | 20017-2151 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194725184 | Gail S Kerr | Internal Medicine | 1140 Varnum St Ne, Suite #201, Washington, DC 20017-2151 | 2005-07-31 |
| 1144641713 | Capital Consulting Services, LLC | Internal Medicine | 1140 Varnum St Ne, Pmb 105, Washington, DC 20017-2151 | 2013-12-26 |
| 1457693012 | Phs Medical Specialists Pmb107 | General Acute Care Hospital | 1140 Varnum St Ne, Pmb107, Washington, DC 20017-2151 | 2013-03-21 |
| 1710240114 | Dal Yoo Md LLC | Internal Medicine | 1140 Varnum St Ne, Suite 102, Washington, DC 20017-2151 | 2012-06-20 |
| 1750659272 | Phs Family Medicine & Pediatrics Pmb103 | Pediatrics | 1140 Varnum St Ne, Pmb103, Washington, DC 20017-2151 | 2011-12-12 |
| 1326316936 | Phs Internal Medicine Pmb202 | General Acute Care Hospital | 1140 Varnum St Ne, Pmb 202, Washington, DC 20017-2151 | 2011-12-09 |
| 1457666000 | Nana Yaw Asamoah-mensah, M.d.,p.c. | Psychiatry & Neurology | 1140 Varnum St Ne, Suite 205, Washington, DC 20017-2153 | 2010-08-06 |
| 1730492422 | Andre S Michalak Md PC | Clinic/Center | 1140 Varnum St Ne, Suite 208b, Washington, DC 20017-2151 | 2010-07-22 |
| 1922335561 | Bustos & Associates, LLC | Preferred Provider Organization | 1140 Varnum St Ne, Pmb 105, Washington, DC 20017-2151 | 2009-11-03 |
| 1740415264 | Mikel Anne Hofmann | Family Medicine | 1140 Varnum St Ne, Ste 200, Washington, DC 20017-2153 | 2009-05-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588215479 | Janet Achankeng Folem | Psychologist | 7100 Varnum St Ne, Suit 218, Washington, DC 20017 | 2019-09-23 |
| 1013475284 | Raphaelia Agnes Johnson-phillips | Technician | 440 Taylor St. Ne Building B Apt 22, Washington Dc, DC 20017 | 2019-03-06 |
| 1528551413 | Harpreet Saluja | Student in an Organized Health Care Education/Training Program | 1150 Varnum St Ne, Providence Hospital Im Department, Washington, DC 20017 | 2018-06-14 |
| 1134638042 | Jane Hayashi-kim | Speech-Language Pathologist | 3910 9th St Ne, Apartment 3, Washington, DC 20017 | 2017-09-22 |
| 1346766102 | Aaliyah Gabrielle Jones | Technician | 611edgewood Ne, Washington, DC 20017 | 2017-08-14 |
| 1417479197 | Javalin Singh | Home Health Aide | Hsc Pediatric Center 1731 Bunker Hill Rd, Washington, DC 20017 | 2017-07-13 |
| 1386174175 | Genevieve Wells | Home Health Aide | 601 Edgewood St. Ne, Apt 706, Washington, DC 20017 | 2017-06-14 |
| 1487183810 | Valerie Anne Pierre | Student in an Organized Health Care Education/Training Program | 1150 Varnum Street, N.e., Acc 209, Washington, DC 20017 | 2017-06-08 |
| 1639600984 | Liliana Tatum | Counselor | 1428 Hamlin Street Ne, Washington, DC 20017 | 2017-03-27 |
| 1750835435 | Marie Hortense Mabou Sando | Home Health Aide | 1416 9th Street Nwdc, Washington, DC 20017 | 2016-08-10 |
| Find all providers in zip 20017 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073991246 | Ronak Dixit | Otolaryngology | 106 Irving St Nw Ste 2700, Washington, DC 20010-2986 | 2015-05-08 |
| 1881000172 | Maria Koenigs | Otolaryngology | 111 Michigan Ave Nw Ste 3w-800, Washington, DC 20010-2916 | 2014-07-08 |
| 1427492727 | William Zhuolei Gao | Otolaryngology | 106 Irving St Nw Ste 2700 North, Washington, DC 20010-2986 | 2013-04-17 |
| 1770841934 | Kaashif Eazazuddin | Otolaryngology | 106 Irving St Nw Ste 410, Washington, DC 20010-2900 | 2012-04-25 |
| 1861759870 | Jonathan Peter Giurintano | Otolaryngology | 3800 Reservoir Rd Nw Bldg 1, Washington, DC 20007 | 2012-04-15 |
| 1306168638 | Assad S. Khoury, M.d., P.C. | Otolaryngology | 4910 Massachusetts Avenue, N.w., Suite 303, Washington, DC 20016-4300 | 2010-03-01 |
| 1518008580 | Manish Khanna | Otolaryngology | 2021 K St Nw Ste 206, Washington, DC 20006 | 2007-02-10 |
| 1902942295 | Washington Ear, Nose and Throat, LLC | Otolaryngology | 80 Landings Dr Ste 207, Washington, PA 15301-9408 | 2007-01-30 |
| 1356419824 | Rondi Kathleen Walker | Otolaryngology | 3301 New Mexico Avenue Nw, #252, Washington, DC 20016-3610 | 2006-12-01 |
| 1386733970 | Mark Vincent Alexander | Otolaryngology | Veterans Affairs Medical Ctr Wash Dc Surgery Dept, 50 Irving Street N.w., Washington, DC 20422-0001 | 2006-10-12 |
| Find all providers in WASHINGTON | ||||
| City | WASHINGTON |
| Zip Code | 20017 |
Please comment or provide details below to improve the information on PROVIDENCE HEALTH SERVICES, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.