NPIMap

Organization Active NPI

Providence Health Services, Inc

Doing business as PHS Unity Healthcare Parkside Radiology

  • Radiology Clinic/Center
  • Washington, DC
National Provider Identifier
1730690801
Registry record updated Oct 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
HFD01-0212 Issued in DC
Legal business name
PROVIDENCE HEALTH SERVICES, INC
Doing business as
PHS Unity Healthcare Parkside Radiology
Practice address
765 Kenilworth Ter NE
Washington, DC 20019-1898
Phone
(202) 299-1796
Fax
(202) 388-8164
NPI assigned
Oct 17, 2017
Last updated
Oct 17, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 17, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Beau Higginbothan
Title
Vice President/Coo
Phone
(410) 368-3162

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X HFD01-0212 DC Primary

Addresses

Primary practice location

765 Kenilworth Ter NE
Washington, DC 20019-1898

Mailing address

1150 Varnum St NE
St Catherines Hall, Room 102
Washington, DC 20017-2104
Phone (202) 854-4069

Other names 1

  • PHS Unity Healthcare Parkside Radiology Doing business as

National Provider Directory

National Provider Directory
Tax ID family
PHS Emergency Room Serv18 organizations share this tax ID, including this one
Part of
Emerg Med Providence Ho

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1508198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508198400000",
    "number": "1730690801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE",
            "address_2": "ST CATHERINES HALL, ROOM 102",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172104",
            "telephone_number": "202-854-4069",
            "fax_number": "202-854-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 KENILWORTH TER NE",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200191898",
            "telephone_number": "202-299-1796",
            "fax_number": "202-388-8164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SERVICES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HOSPITAL",
        "enumeration_date": "2017-10-17",
        "last_updated": "2017-10-17",
        "status": "A",
        "authorized_official_last_name": "HIGGINBOTHAN",
        "authorized_official_first_name": "BEAU",
        "authorized_official_title_or_position": "VICE PRESIDENT/COO",
        "authorized_official_telephone_number": "410-368-3162"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHS Unity Healthcare Parkside Radiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.