Provider Demographics
| NPI: | 1144250176 |
|---|---|
| Name: | ST AGNES HEALTHCARE INC |
| Entity type: | Organization |
| Organization Name: | ST AGNES HEALTHCARE INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT/CEO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | WILLIAM |
| Authorized Official - Middle Name: | B |
| Authorized Official - Last Name: | HIGGINBOTHAM |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 667-234-3162 |
| Mailing Address - Street 1: | 3585 WASHINGTON BLVD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HALETHORPE |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 21227-1676 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 667-234-2149 |
| Mailing Address - Fax: | 667-234-8644 |
| Practice Address - Street 1: | 900 CATON AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | BALTIMORE |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 21229-5201 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 667-234-2149 |
| Practice Address - Fax: | 667-234-8644 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | ST AGNES HEALTHCARE INC |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-07-04 |
| Last Update Date: | 2025-06-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MD | 216121400 | Medicaid | |
| MD | W662 | Other | CAREFIRST BCBS |
| MD | W662 | Other | CAREFIRST BCBS |
| DC | W662 | Other | BCBS |
