Provider Demographics
NPI:1902802861
Name:SELECT SPECIALTY HOSPITAL - ARIZONA INC
Entity Type:Organization
Organization Name:SELECT SPECIALTY HOSPITAL - ARIZONA INC
Other - Org Name:SELECT SPECIALTY HOSPITAL - ARIZONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-972-1100
Mailing Address - Street 1:4714 GETTYSBURG RD
Mailing Address - Street 2:LEGAL DEPT.
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4325
Mailing Address - Country:US
Mailing Address - Phone:717-972-1100
Mailing Address - Fax:717-975-9981
Practice Address - Street 1:1012 E WILLETTA ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2749
Practice Address - Country:US
Practice Address - Phone:480-675-6016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSH2354282E00000X
AZSH3050282E00000X
AZSH3047282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0207750OtherBCBS AZ
AZ486028Medicaid
AZAZ0208070OtherBCBS AZ (PHOENIX DTOWN)
AZ707721Medicaid
AZ707739Medicaid
AZAZ0208080OtherBCBS AZ (SCOTTSDALE)
AZIZ0120OtherHEALTHNET
AZ707739Medicaid