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Contact Information

PHS GEN SURG DP307
1160 VARNUM ST NE
DEPAUL 307
WASHINGTON, DC20017-2107
 Phone: 202-854-4014
 Fax: 202-854-4082
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery

208600000X 02 Physician/General Surgery
 

General Acute Care Hospital

282N00000X A0[7] Hospital-General
Indicates primary specialty

NPI Profile & details for PHS GEN SURG DP307

NPI Number 1942546858
LBN Legal business name PHS GEN SURG DP307
Authorized official BEAU HIGGINBOTHAM - (CIVE PRESIDENT/COO)
Entity Organization
Organization subpart 1 Yes
Enumeration date 12/20/2012
Last updated 10/05/2017 - About 9 years ago
Identifiers
DC License # HFD01-0212
DC Medicaid 029833400
MD Medicaid 005145400
VA Medicaid 09810714
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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