UPI (Provider ID): 1007
Change Report (if Any):

Short Name: ST RITA MEDICAL

Long Name 1: SAINT RITAS MEDICAL CENTER
Long Name 2:

Address 1: 730 WEST MARKET STREET
Address 2:

City: LIMA
Zip Code: 458014667
County: ALLE

Contact: PAUL BROCK
Title: AD
Phone: 4192269642
FAX: 4192269608

Vendor: 1007

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012