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General NPI Number Information
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NPI Number | 1548562119
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Entity Type | Organization
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Legal Business Name | ST. AGNES HEALTHCARE, INC.
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Dates
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Enumeration Date | 12/02/2010
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 11055 LITTLE PATUXENT PKWY L6
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City | COLUMBIA
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State | MD
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Zip | 21044-2896
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Country | US
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Telephone | 410-730-9775
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21182
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City | BALTIMORE
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State | MD
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Zip | 21228
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Country | US
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Telephone | 410-368-8640
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | BONNIE L. PHIPPS
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Credential |
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Telephone | 410-368-2101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | A1463
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License Number State | MD
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