Provider Demographics
NPI:1710120423
Name:SELECT PROVIDER NETWORKS, INC.
Entity Type:Organization
Organization Name:SELECT PROVIDER NETWORKS, 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:717-972-1100
Mailing Address - Street 1:500 RIVERHILLS BUSINESS PARK STE 500
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5039
Mailing Address - Country:US
Mailing Address - Phone:205-995-5668
Mailing Address - Fax:205-995-5023
Practice Address - Street 1:500 RIVERHILLS BUSINESS PARK STE 500
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5039
Practice Address - Country:US
Practice Address - Phone:205-995-5668
Practice Address - Fax:205-995-5023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-10
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy