Provider Demographics
NPI:1861492217
Name:SELECT SPECIALTY HOSPITAL - ZANESVILLE INC
Entity Type:Organization
Organization Name:SELECT SPECIALTY HOSPITAL - ZANESVILLE INC
Other - Org Name:SELECT SPECIALTY HOSPITAL - SOUTHEAST OHIO
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 1:2000 TAMARACK RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1183
Practice Address - Country:US
Practice Address - Phone:740-588-7854
Practice Address - Fax:740-588-7856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1450282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH030034100OtherBLACK LUNG
OH2483585Medicaid
OH000000343190OtherANTHEM OH
OH030508538003OtherMEDICAL MUTUAL OF OHIO
OH030508538003OtherMEDICAL MUTUAL OF OHIO
OH030034100OtherBLACK LUNG