Healthcare Provider Details

I. General information

NPI: 1730909367
Provider Name (Legal Business Name): ST. AGNES HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501D BALTIMORE NATIONAL PIKE
CATONSVILLE MD
21228-3923
US

IV. Provider business mailing address

6501D BALTIMORE NATIONAL PIKE
CATONSVILLE MD
21228-3923
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-0549
  • Fax:
Mailing address:
  • Phone: 410-740-0549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM B HIGGINBOTHAM
Title or Position: PRESIDENT/CEO
Credential:
Phone: 667-234-3162