Basic Information
Provider Information
NPI: 1104490341
EntityType: 2
ReplacementNPI:  
OrganizationName: SELECT SPECIALTY HOSPITAL - TUCSON, LLC
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Mailing Information
Address1: 4714 GETTYSBURG RD
Address2: LEGAL DEPT
City: MECHANICSBURG
State: PA
PostalCode: 17055
CountryCode: US
TelephoneNumber: 7179721100
FaxNumber:  
Practice Location
Address1: 355 N WILMOT RD
Address2:  
City: TUCSON
State: AZ
PostalCode: 857112601
CountryCode: US
TelephoneNumber: 7179721100
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/13/2021
LastUpdateDate: 05/13/2021
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AuthorizedOfficialLastName: TARVIN
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VP
AuthorizedOfficialTelephone: 7179754503
IsSoleProprietor:  
IsOrganizationSubpart: N
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NPICertificationDate: 05/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282E00000X  Y HospitalsLong Term Care Hospital 

No ID Information.


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