| NPI | 1629389630 |
|---|---|
| Doing Business As | ST. AGNES PROFESSIONAL SERVICES |
| Entity Type | Organization |
| Authorized Contact | KEITH VANDER KOLK President/CEO 667-234-2101 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease |
| 207RP1001X Internal Medicine, Pulmonary Disease | |
| 2086S0129X Surgery, Vascular Surgery | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2016-02-25 |