NPIMap

Organization Active NPI

PHS Center for Life SC 2ND Floor

  • Gynecology Physician
  • Washington, DC
National Provider Identifier
1831467356
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
HFD01-0212 Issued in DC
Legal business name
PHS CENTER FOR LIFE SC 2ND FLOOR
Practice address
1150 Varnum St NE
St. Catherine'S Hall, 2ND Floor
Washington, DC 20017-2107
Phone
(202) 269-7074
Fax
(202) 372-0026
NPI assigned
Dec 12, 2011
Organization subpart
Yes
Parent organization
PROVIDENCE HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Beau Higginbotham
Title
VP
Phone
(410) 368-3162

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X HFD01-0212 DC
Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VG0400X HFD01-0212 DC Primary
General Acute Care Hospital 282N00000X HFD01-0212 DC

Addresses

Primary practice location

1150 Varnum St NE
St. Catherine'S Hall, 2ND Floor
Washington, DC 20017-2107

Mailing address

1150 Varnum St NE RM 102
Washington, DC 20017-2104
Phone (202) 854-7074

Other identifiers 3

IdentifierTypeStateIssuer
029833400MedicaidDC
09810714MedicaidVA
005145400MedicaidMD

Other names 1

  • Providence Health Services Other name

National Provider Directory

National Provider Directory
Tax ID family
PHS Ctr for Geriatric Medicine Dp02123 organizations share this tax ID, including this one
Part of
PHS Ctr for Geriatric Medicine Dp021

Other organizations with this tax ID 22

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

View all 22

Locations

1150 Varnum St NE
Fl 2
Washington, DC 20017
Phone (202) 854-7074

NPI Registry JSON

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

{
    "created_epoch": "1323648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1831467356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE RM 102",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172104",
            "telephone_number": "202-854-7074",
            "fax_number": "202-854-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 VARNUM ST NE",
            "address_2": "ST. CATHERINE'S HALL, 2ND FLOOR",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200172107",
            "telephone_number": "202-269-7074",
            "fax_number": "202-372-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHS CENTER FOR LIFE SC 2ND FLOOR",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HOSPITAL",
        "enumeration_date": "2011-12-12",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HIGGINBOTHAM",
        "authorized_official_first_name": "BEAU",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "410-368-3162",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "DC",
            "license": "HFD01-0212",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029833400",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09810714",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005145400",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Health Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jul 21, 2022; 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.