MEDICARE: SELECT SPECIALTY HOSPITAL - SOUTH DALLAS 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	007859	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HH1028	OTHER	TX	BCBS TX

General Provider Information

NPI Number	:	1518967074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELECT SPECIALTY HOSPITAL - SOUTH DALLAS 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	:	3500 W WHEATLAND RD
Second Line	:	4TH FLOOR
City	:	DALLAS
State	:	TX
Zip	:	75237-3460
Country	:	US
Telephone Number	:	972-780-6514
Fax Number	:	972-298-4860

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	06/14/2012

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