Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Providence Health Services, Inc

Organization Sports Medicine (Orthopaedic Surgery) Physician · NPI 1689005720

Providence Health Services, Inc is a Sports Medicine (Orthopaedic Surgery) Physician in Washington, District of Columbia. Licensed in District of Columbia. Registered with an NPI since 2013.

Licensed in
DC
In the registry since
2013
Specialties on file
2
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1160 Varnum St NE Depaul 312
Washington, DC 20017-2107
Phone: (202) 534-4400
Fax: (202) 435-4412
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Sports Medicine (Orthopaedic Surgery) Physician (primary) Taxonomy 207XX0005X · Licence HFD01-0212 (DC)
General Acute Care Hospital Taxonomy 282N00000X · Licence HFD01-0212 (DC)

Record details

NPI number1689005720
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationProvidence Hospital
Authorized official Beau Higginbotham — Vice President/Coo · (410) 368-3162
NPI enumeratedNovember 27, 2013
Last updated in NPPESOctober 9, 2017
Mailing addressPo Box 418893, Boston, MA 02241-8893

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