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General NPI Number Information
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NPI Number | 1699328245
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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 | 07/23/2019
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Last Update Date | 07/23/2019
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Provider Practice Location Address
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Address Line | 900 CATON AVE
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City | BALTIMORE
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State | MD
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Zip | 21229-5201
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Country | US
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Telephone | 667-234-2800
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Fax | 667-234-3532
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Provider Business Mailing Address
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Address Line | 3585 WASHINGTON BLVD
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City | HALETHORPE
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State | MD
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Zip | 21227-1676
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Country | US
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Telephone | 667-234-2149
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Fax | 667-234-8644
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Authorized Official
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Title or Position | VICE-PRESIDENT/CFO
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Name | SCOTT MATTHEW FURNISS
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Credential |
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Telephone | 410-368-3130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number |
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License Number State |
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