MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 1636
Change Report (if Any):

Short Name: MIAMI CNTY RECV

Long Name 1: MIAMI COUNTY RECOVERY COUNCIL
Long Name 2:

Address 1: 1059 NORTH MARKET STREET
Address 2:

City: TROY
Zip Code: 453731433
County: MIAM

Contact: DEBI JACOBS
Title: MANGR
Phone: 9373354543
FAX: 9373398371

Vendor: 1636

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/12/2011

File Produced: 19MAY2012