Provider Demographics
NPI:1073814059
Name:BALTIMORE CITY PUBLIC SCHOOLS
Entity type:Organization
Organization Name:BALTIMORE CITY PUBLIC SCHOOLS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER, TPB TECHNICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:EMILIE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-396-8948
Mailing Address - Street 1:200 E NORTH AVE
Mailing Address - Street 2:THIRD PARTY BILLING ROOM 318
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-5910
Mailing Address - Country:US
Mailing Address - Phone:410-396-8948
Mailing Address - Fax:410-545-6128
Practice Address - Street 1:200 E NORTH AVE
Practice Address - Street 2:THIRD PARTY BILLING ROOM 318
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5910
Practice Address - Country:US
Practice Address - Phone:410-396-8948
Practice Address - Fax:410-545-6128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALTIMORE CITY PUBLIC SCHOOLS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD166301100Medicaid