| Providence Health Services | |
|
1140 Varnum St Ne Pmb103 Washington DC 20017-2151 | |
| (202) 854-7074 | |
| (202) 854-7470 |
| Full Name | Providence Health Services |
|---|---|
| Speciality | Family 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 Pmb103 Washington DC 20017-2151 Ph: (202) 854-7074 |
| NPI Number | 1750659272 |
|---|---|
| Provider Enumeration Date | 12/12/2011 |
| Last Update Date | 09/06/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750659272 | NPI | - | NPPES |
| 005145100 | Medicaid | MD | |
| 029833400 | Medicaid | DC | |
| 09810714 | Medicaid | VA |
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