PROVIDENCE HEALTH SERVICES, INC (NPI# 1972012615) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972012615 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH SERVICES, INC |
| Other Organization Name | PHS GYN GROUP |
| Practice Address |
1150 Varnum St Ne St Catherine's Hall, 2nd Floor Washington DC 20017-2107 |
| Mailing Address |
1160 Varnum St Ne Ste 102 Washington DC 20017-2106 |
| Practice Telephone | 2028547074 |
| Practice Fax Number | 2028547470 |
| Mailing Telephone | 2028544069 |
| Mailing Fax Number | 2028547825 |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2017-10-11 |
| Authorized Official Name | BEAU HIGGINBOTHAN (VICE PRESIDENT/COO) |
| Authorized Official Telephone | 4103683162 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207VG0400X |
Obstetrics & Gynecology Specialization: Gynecology |
HFD01-0212 | DC | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PHS GYN GROUP | 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 |
| 1689005720 | Providence Health Services, Inc | General Acute Care Hospital | 1160 Varnum St Ne, Depaul 312, Washington, DC 20017-2107 | 2013-11-27 |
| 1366710766 | Providence Health Services, Inc | General Acute Care Hospital | 1140 Varnum St Ne, Pmb 200, Washington, DC 20017-2151 | 2011-12-13 |
| 1619245222 | Providence Health Services, Inc | Family Medicine | 128 M St Nw, Washington, DC 20001-1205 | 2011-12-09 |
| Street Address |
1150 VARNUM ST NE ST CATHERINE'S HALL, 2ND FLOOR |
| City | WASHINGTON |
| State | DC |
| Zip Code | 20017-2107 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386648657 | Heather J Wayco | Dietitian, Registered | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2005-06-02 |
| 1508406653 | Pamela Fru Tange Oriaifo | Nurse Practitioner | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2020-01-07 |
| 1952946824 | Amarachi Angelina Nnamdi-eze | Physical Therapy Assistant | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2019-11-14 |
| 1598313595 | Providence Health Services, Inc | Clinic/Center | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2019-09-03 |
| 1861057416 | Providence Hospital | Clinic/Center | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2019-05-08 |
| 1861954638 | Providence Hospital | Emergency Medicine | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2019-04-02 |
| 1457837619 | Daniel Fernandez | Internal Medicine | 1150 Varnum St Ne, Washington, DC 20017 | 2018-07-11 |
| 1104311018 | Iman Fatima Musah | Anesthesiologist Assistant | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2018-06-25 |
| 1164923348 | Joy R Hudson | Social Worker | 1150 Varnum St Ne, Washington, DC 20017-2180 | 2018-02-23 |
| 1740795293 | Providence Health Services, Inc | Nurse Anesthetist, Certified Registered | 1150 Varnum St Ne, Washington, DC 20017-2104 | 2017-12-06 |
| 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 | 207VG0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| Specialization | Gynecology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346416484 | Gaby N Moawad | Obstetrics & Gynecology | 2150 Pennsylvania Ave Nw Ste 6a, Washington, DC 20037-3201 | 2008-05-07 |
| 1801062476 | Sheetal Gaurang Sheth | Obstetrics & Gynecology | 2300 Eye Street Nw, Suite 707, Washington, DC 20037 | 2008-05-05 |
| 1467647776 | Michael Angelo Basco | Obstetrics & Gynecology | 1115 4th St Se, Washington, DC 20003-3440 | 2007-09-10 |
| 1598854903 | Howard Neil Smith | Obstetrics & Gynecology | 1145 Nineteenth St Nw, Suite 510, Washington, DC 20036 | 2006-10-12 |
| 1588768691 | Margaret A Byrne Md PC | Obstetrics & Gynecology | 2440 M St, #501, Washington, DC 20037 | 2006-09-11 |
| 1659301687 | Sara L Imershein | Obstetrics & Gynecology | 1225 4th St Ne, Washington, DC 20002-3431 | 2006-07-04 |
| 1942287271 | Brenda S Peacock | Obstetrics & Gynecology | 1204 Brown St, Washington, NC 27889-4671 | 2005-12-28 |
| 1932470549 | Northern Virginia Pelvic Surgery Associates | Obstetrics & Gynecology | 5215 Loughboro Rd Nw, Suite 500, Washington, DC 20016-2618 | 2012-01-13 |
| 1922304708 | Dianne Cresswell Cinnamon | Obstetrics & Gynecology | 920 Varnum St Ne, Washington, DC 20017-2145 | 2011-01-27 |
| 1316263817 | Maria Victoria Vargas | Obstetrics & Gynecology | 2150 Pennsylvania Ave Nw, Floor 6a, Suite 6a-426, Washington, DC 20037-3201 | 2010-04-09 |
| Find all providers in WASHINGTON | ||||
| City | WASHINGTON |
| Zip Code | 20017 |
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| 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.