| Entity Name: | SELECT SPECIALTY HOSPITAL - PANAMA CITY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Profit |
| Status: | Active |
| Date Filed: | 07 Feb 2002 (23 years ago) |
| Document Number: | F02000000698 |
| FEI/EIN Number | 383647406 |
| Address: | 4714 GETTYSBURG ROAD, MECHANICSBURG, PA, 17055 |
| Mail Address: | 4714 GETTYSBURG ROAD, LEGAL DEPT, MECHANICSBURG, PA, 17055 |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194725713 | 2005-07-26 | 2010-09-02 | 4714 GETTYSBURG RD, LEGAL DEPT., MECHANICSBURG, PA, 170554325, US | 615 N BONITA AVE, PANAMA CITY, FL, 324013623, US | |||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||
| Phone | +1 717-972-1100 |
| Fax | 7179759981 |
| Phone | +1 850-767-3199 |
| Fax | 8507673181 |
Authorized person
| Name | MR. MICHAEL E. TARVIN |
| Role | VICE PRESIDENT |
| Phone | 7179721100 |
Taxonomy
| Taxonomy Code | 282E00000X - Long Term Care Hospital |
| License Number | 4475 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0103438-00 |
| State | FL |
| Issuer | BLUE CROSS FL |
| Number | 141 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Mullin Thomas P | President | 4714 GETTYSBURG ROAD, MECHANICSBURG, PA, 17055 |
| Name | Role | Address |
|---|---|---|
| TARVIN MICHAEL E | Vice President | 4714 GETTYSBURG ROAD, MECHANICSBURG, PA, 17055 |
| Veit Joel T | Vice President | 4714 GETTYSBURG ROAD, MECHANICSBURG, PA, 17055 |
| DUGGAN JOHN F | Vice President | 4714 GETTYSBURG ROAD, MECHANICSBURG, PA, 17055 |
| Name | Role | Address |
|---|---|---|
| DUGGAN JOHN F | Assistant Secretary | 4714 GETTYSBURG ROAD, MECHANICSBURG, PA, 17055 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 2005-01-18 | SELECT SPECIALTY HOSPITAL - PANAMA CITY, INC. | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
