| Providence Health Services, Inc | |
|
1140 Varnum St Ne Ste 100 Washington DC 20017 | |
| (202) 854-7623 | |
| (202) 854-7616 |
| Full Name | Providence Health Services, Inc |
|---|---|
| Speciality | Psychiatry & Neurology - Neurology |
| Location | 1140 Varnum St Ne Ste 100, Washington, District Of Columbia |
| Authorized Official Name and Position | Mitchell Lomax (VICE PRESIDENT/CFO) |
| Authorized Official Contact | 6672342926 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Health Services, Inc 1150 Varnum St Ne St Catherines Hall 102 Washington DC 20017-2180 Ph: (202) 854-4069 | Providence Health Services, Inc 1140 Varnum St Ne Ste 100 Washington DC 20017 Ph: (202) 854-7623 |
| NPI Number | 1609031632 |
|---|---|
| Provider Enumeration Date | 07/18/2008 |
| Last Update Date | 10/20/2023 |
| Certification Date | 10/20/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609031632 | NPI | - | NPPES |
| 985415100 | Medicaid | MD |
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