MEDICARE: SELECT SPECIALTY HOSPITAL - FORT WAYNE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282E00000X	Long Term Care Hospital	009856	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000246982	OTHER	IN	BCBS IN

General Provider Information

NPI Number	:	1104825140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELECT SPECIALTY HOSPITAL - FORT WAYNE INC

Provider Business Mailing Address
First Line	:	4714 GETTYSBURG RD
Second Line	:	LEGAL DEPT.
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-972-1100
Fax Number	:	717-975-9981

Provider Business Practice Location Address
First Line	:	700 BROADWAY
Second Line	:	7TH FL EAST
City	:	FORT WAYNE
State	:	IN
Zip	:	46802-1402
Country	:	US
Telephone Number	:	260-425-3811
Fax Number	:	260-425-3812

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MICHAEL E. TARVIN
Credential	:
Telephone Number	:	717-972-1100

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	09/02/2010

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