UPI (Provider ID): 10139
Change Report (if Any):

Short Name: MH ACCESS POINT

Long Name 1: CENTRAL CLINIC
Long Name 2: MENTAL HEALTH ACCESS POINT

Address 1: 311 ALBERT SABIN WAY
Address 2:

City: CINCINNATI
Zip Code: 452292801
County: HAMI

Contact: DAVID BAGENT
Title: OPER
Phone: 5135585823
FAX: 5135583880

Vendor: 10139

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 01/20/2012

File Produced: 19MAY2012