Provider Demographics
NPI:1962493403
Name:COMPTROLLER OF MARYLAND CENTRAL PAYROLL BUREAU
Entity Type:Organization
Organization Name:COMPTROLLER OF MARYLAND CENTRAL PAYROLL BUREAU
Other - Org Name:SPRING GROVE HOSPITAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:HELSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-402-7455
Mailing Address - Street 1:55 WADE AVE
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4663
Mailing Address - Country:US
Mailing Address - Phone:410-402-7455
Mailing Address - Fax:410-402-7094
Practice Address - Street 1:55 WADE AVE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4663
Practice Address - Country:US
Practice Address - Phone:410-402-7455
Practice Address - Fax:410-402-7094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03040273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK752Medicare PIN
MD214018Medicare ID - Type Unspecified