Healthcare Provider Details

I. General information

NPI: 1427870591
Provider Name (Legal Business Name): ST. AGNES HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6740 ALEXANDER BELL DR STE 302
COLUMBIA MD
21046-2248
US

IV. Provider business mailing address

6740 ALEXANDER BELL DR STE 302
COLUMBIA MD
21046-2248
US

V. Phone/Fax

Practice location:
  • Phone: 667-234-2910
  • Fax:
Mailing address:
  • Phone: 667-234-2910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

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