Phs Internal Medicine Dp317
Internal Medicine in Washington, DC. Organization (NPI-2).
Details
- NPI
- 1043474497
- Entity type
- Organization (NPI-2)
- Legal business name
- Phs Internal Medicine Dp317
- Organization subpart
- Yes
- Enumeration date
- Jul 15, 2008
- Last updated
- Oct 10, 2017
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | HFD01-0212 | DC | Yes |
Other names
- Providence Health Services (Other Name)
Practice location
1160 Varnum St NeDepaul 317
Washington, DC 20017-2107
Phone 202-640-4837 · Fax 202-636-1138
Mailing address
1160 Varnum St NeSt Catherine'S Hall, Room 102
Washington, DC 20017-2107
Phone 202-854-4069 · Fax 202-854-7825
Authorized official
Beau Higginbotham
Vice President/Coo
4103683162
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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