Provider Demographics
NPI:1942025630
Name:ST. AGNES HEALTHCARE, INC.
Entity type:Organization
Organization Name:ST. AGNES HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
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 1:6740 ALEXANDER BELL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2250
Mailing Address - Country:US
Mailing Address - Phone:667-234-6885
Mailing Address - Fax:443-708-9346
Practice Address - Street 1:6740 ALEXANDER BELL DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2250
Practice Address - Country:US
Practice Address - Phone:667-234-6885
Practice Address - Fax:443-708-9346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Single Specialty