| Providence Health Services | |
|
1140 Varnum St Ne Pmb 202 Washington DC 20017-2151 | |
| (202) 854-4242 | |
| (202) 854-4245 |
| Full Name | Providence Health Services |
|---|---|
| Speciality | Internal Medicine |
| Location | 1140 Varnum St Ne, Washington, District Of Columbia |
| Authorized Official Name and Position | Charles F Haberkern (VP) |
| Authorized Official Contact | 2028544255 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Health Services 1160 Varnum St Ne St Catherine's Hall, Room 102 Washington DC 20017-2107 Ph: (202) 854-4069 | Providence Health Services 1140 Varnum St Ne Pmb 202 Washington DC 20017-2151 Ph: (202) 854-4242 |
| NPI Number | 1326316936 |
|---|---|
| Provider Enumeration Date | 12/09/2011 |
| Last Update Date | 09/06/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326316936 | NPI | - | NPPES |
| 005145400 | Medicaid | MD | |
| 09810714 | Medicaid | VA | |
| 029833400 | Medicaid | DC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | HFD01-0212 (District Of Columbia) | Primary |
| 282N00000X | General Acute Care Hospital | HFD01-0212 (District Of Columbia) | Secondary |
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