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PROVIDENCE HEALTH SERVICES
NPI 1043474497
Internal Medicine in Washington, DC

Active since July 15, 2008CLIA 09D2273468 · Waiver
1160 VARNUM ST NE, DEPAUL 317, WASHINGTON, DC 20017(202) 640-4837(202) 636-1138 Get Directions Write a Review

NPPES record last updated: October 10, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Providence Health Services NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE HEALTH SERVICES (NPI 1043474497) is a healthcare organization registered as an internal medicine in Washington, District Of Columbia and active in the NPI registry since July 2008. The organization holds a CLIA Waiver certificate valid through December 12, 2026 and lists Beau Higginbotham, Vice President/coo, as its authorized official.

NPPES Registry Identity

NPI1043474497
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NamePHS INTERNAL MEDICINE DP317
Location Address1160 VARNUM ST NE, DEPAUL 317Washington, DC 20017-2107
Mailing Address1160 Varnum St Ne, St Catherine's Hall, Room 102Washington, DC 20017-2107 · (202) 854-4069 · Fax (202) 854-7825
Phone(202) 640-4837
Fax(202) 636-1138
Organization SubpartYesParent: Providence Hospital
Authorized OfficialBeau HigginbothamVice President/coo · (410) 368-3162
Enumeration DateJuly 15, 2008
Last NPPES UpdateOctober 10, 2017
✔ NPI 1043474497 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in DC · HFD01-0212
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
1160 VARNUM ST NE, Washington, DC 20017
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Other Names 1

Other NameProvidence Health Services

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 09D2273468

Providence Health System · Washington, DC
Active · expires Dec 12, 2026
CLIA Number09D2273468
Laboratory TypePhysician Office
Certificate Effective DateDecember 13, 2024
Certificate Expiration DateDecember 12, 2026
Laboratory DirectorDr. Shadi Soufi
Laboratory Phone(202) 854-7919
Laboratory LocationProvidence Health System1160 Varnum St NE, Washington, DC 20017
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. UCHENNA ANTHONIA OBICHERE CRNP
Nurse Practitioner (Psychiatric/Mental Health)
1160 VARNUM ST NE, SUITE 317
WASHINGTON, DC 20017
District of Columbia (202) 636-1130
YULIZA ABIGAIL LEMUS GAMES
Behavior Technician
1160 VARNUM ST NE
WASHINGTON, DC 20017
District of Columbia (202) 525-1448
ANITA KUNWAR MD
Internal Medicine
1160 VARNUM ST NE
WASHINGTON, DC 20017
District of Columbia (202) 854-7785
RESOURCE PHARMACY INCORPORATED
Pharmacist
1160 VARNUM ST NE
WASHINGTON, DC 20017
District of Columbia (202) 832-2200
PHS MULTISPECIALTY SERVICES
Surgery
1160 VARNUM ST NE, DEPAUL 300
WASHINGTON, DC 20017
District of Columbia (202) 854-4014
PHS INTERNAL MEDICINE DP311
Internal Medicine
1160 VARNUM ST NE, DEPAUL 311
WASHINGTON, DC 20017
District of Columbia (202) 854-4470
BRANDI DENISE FISHER
Behavior Technician
1160 VARNUM ST NE
WASHINGTON, DC 20017
District of Columbia (202) 525-1448
STUART LAWRENCE HORWITZ MD
Internal Medicine (Gastroenterology)
1160 VARNUM ST NE, 311
WASHINGTON, DC 20017
District of Columbia (202) 832-2880

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Phs Internal Medicine Dp317's NPI number?

The NPI number for Phs Internal Medicine Dp317 is 1043474497. It was assigned to this organization in the NPPES registry on July 15, 2008. The provider is also known as Providence Health Services.

Where is Phs Internal Medicine Dp317 located?

Phs Internal Medicine Dp317 is located at 1160 Varnum St NE Depaul 317, Washington, DC 20017. The listed phone number is (202) 640-4837.

What is Phs Internal Medicine Dp317's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Phs Internal Medicine Dp317 hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 09D2273468) is associated with this NPI, valid through December 12, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Phs Internal Medicine Dp317 was last updated on October 10, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.