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General NPI Number Information
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NPI Number | 1861954638
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HOSPITAL
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 1150 VARNUM ST NE
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City | WASHINGTON
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State | DC
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Zip | 20017-2180
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Country | US
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Telephone | 202-854-7001
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Fax | 202-854-7990
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Provider Business Mailing Address
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Address Line | 1150 VARNUM ST NE
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City | WASHINGTON
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State | DC
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Zip | 20017-2180
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Country | US
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Telephone | 202-854-4069
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Fax | 202-854-7825
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Authorized Official
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Title or Position | SR VP FINANCE/CFO
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Name | MR. SCOTT M FURNISS
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Credential |
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Telephone | 202-854-7169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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