Provider Demographics
NPI:1902971864
Name:SELECT MEDICAL, LLC
Entity Type:Organization
Organization Name:SELECT MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VASSAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-225-0045
Mailing Address - Street 1:1046 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-2840
Mailing Address - Country:US
Mailing Address - Phone:918-225-0045
Mailing Address - Fax:
Practice Address - Street 1:1046 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-2840
Practice Address - Country:US
Practice Address - Phone:918-225-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5700950001Medicare NSC