Providence Health Services

LBN: Phs Family Medicine & Pediatrics Pmb103
Providence Health Services is an health care organization with primary practice located at 1140 Varnum St Ne Pmb103, Washington DC 20017-2151. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Pediatrics, Hospitals / General Acute Care Hospital. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty. Phs Family Medicine & Pediatrics Pmb103 can be contacted via phone (202) 854-7074, or through Haberkern, Charles F via phone (202) 854-4255.

Contact Information

Primary practice address
1140 Varnum St Ne Pmb103 Washington DC 20017-2151
Phone: (202) 854-7074
Fax: (202) 854-7470
Website:
Map and Directions
Authorized official contact:
Name: Haberkern, Charles F
Phone: (202) 854-4255

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X HFD01-0212 District of Columbia
Allopathic & Osteopathic Physicians / Pediatrics 208000000X HFD01-0212 District of Columbia
Hospitals / General Acute Care Hospital 282N00000X HFD01-0212 District of Columbia

Profile Details

NPI number 1750659272
LBN Legal business name Phs Family Medicine & Pediatrics Pmb103
DBA Doing business as Providence Health Services
Authorized official Haberkern, Charles F
Entity Organization
Organization subpart 1 Yes
Enumeration date Dec 12th, 2011
Last updated Sep 6th, 2016 - about 8 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750659272 NPPES
Maryland MEDICAID 005145100
Maryland MEDICAID 029833400
Maryland MEDICAID 09810714

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