PROVIDENCE HEALTH SERVICES, INC (NPI# 1679087365) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679087365 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH SERVICES, INC |
| Other Organization Name | PHS OCCUPATIONAL HEALTH/WELLNESS |
| Practice Address |
1150 Varnum St Ne Washington DC 20017-2104 |
| Mailing Address |
1150 Varnum St Ne St Catherines Hall, Room 102 Washington DC 20017-2104 |
| Practice Telephone | 2028544478 |
| Practice Fax Number | 2028544487 |
| Mailing Telephone | 2028544069 |
| Mailing Fax Number | 2028547825 |
| Enumeration Date | 2017-11-17 |
| Last Update Date | 2017-11-17 |
| 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 | 261QX0100X |
Clinic/Center Specialization: Occupational Medicine |
HFD01-0212 | DC | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| PHS Occupational Health/Wellness | 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 |
| 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 |
| 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 |
| City | WASHINGTON |
| State | DC |
| Zip Code | 20017-2104 |
| 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 | 261QX0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Occupational Medicine |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558820787 | Neurosuite LLC | Clinic/Center | 1220 Holbrook Ter Ne Apt B3, Washington, DC 20002-2712 | 2019-03-18 |
| 1639290398 | Northside Medical Services Corporation | Clinic/Center | 4121 Minnesota Ave Ne, Washington, DC 20019-3572 | 2007-04-02 |
| 1619315009 | Gl Medical, Inc. | Clinic/Center | 3300 Pennsylvania Ave Se, Washington, DC 20020-2408 | 2013-06-07 |
| 1821301904 | Immaculate Medical Services LLC | Clinic/Center | 106 Irving St Nw, Suite 308 South, Washington, DC 20010-2927 | 2010-07-19 |
| 1356660773 | Northside Medical Services Corporation | Clinic/Center | 4121 Minnesota Ave Ne, Washington, DC 20019-3572 | 2010-05-25 |
| 1487764882 | Bobby Vitaya Enkvetchakul | Clinic/Center | 851 E 5th St, Suite 152, Washington, MO 63090-3135 | 2006-08-30 |
| 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.