MEDICARE: SELECT SPECIALTY HOSPITAL - INDIANAPOLIS 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	006578	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000097637	OTHER	IN	BCBS IN

General Provider Information

NPI Number	:	1720087620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELECT SPECIALTY HOSPITAL - INDIANAPOLIS INC

Provider Business Mailing Address
First Line	:	4716 OLD GETTYSBURG RD
Second Line	:	LEGAL DEPT.
City	:	MECHANICSBURG
State	:	PA
Zip	:	17055-4325
Country	:	US
Telephone Number	:	717-972-1139
Fax Number	:	717-975-9981

Provider Business Practice Location Address
First Line	:	898 E MAIN ST
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-1407
Country	:	US
Telephone Number	:	317-925-8066
Fax Number	:	317-925-8861

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. MICHAEL E. TARVIN
Credential	:
Telephone Number	:	717-972-1139

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	03/11/2008

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