Basic Information
| Provider Information | |||||||||
| NPI: | 1285909531 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SELECT OUTPATIENT SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 COMPASS RD | ||||||||
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| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600268001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474415593 | ||||||||
| FaxNumber: | 8474414130 | ||||||||
| Practice Location | |||||||||
| Address1: | 7454 NEWCASTLE GOLF CLUB RD | ||||||||
| Address2: | |||||||||
| City: | NEWCASTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980599176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254531508 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2012 | ||||||||
| LastUpdateDate: | 04/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | DEUTSCH | ||||||||
| AuthorizedOfficialFirstName: | NEAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8474415593 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 116893 | 05 | GA | MEDICAID |