Provider Demographics
NPI:1144229626
Name:SELECT SPECIALTY HOSPITAL - COLUMBUS/UNIVERSITY, INC.
Entity Type:Organization
Organization Name:SELECT SPECIALTY HOSPITAL - COLUMBUS/UNIVERSITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-975-4503
Mailing Address - Street 1:4714 GETTYSBURG ROAD
Mailing Address - Street 2:LEGAL DEPARTMENT
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055
Mailing Address - Country:US
Mailing Address - Phone:717-975-4503
Mailing Address - Fax:717-975-9981
Practice Address - Street 1:410 W 10TH AVE
Practice Address - Street 2:1129 DOAN HALL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:717-972-1100
Practice Address - Fax:717-975-9981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2008-11-07
Deactivation Date:2006-08-17
Deactivation Code:
Reactivation Date:2008-11-07
Provider Licenses
StateLicense IDTaxonomies
OH1422282N00000X
OH1423282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH-2047752Medicaid
OHOH-2047752Medicaid