UPI (Provider ID): 1879
Change Report (if Any):

Short Name: MCH PREVENTION

Long Name 1: MADISON COUNTY HOSPITAL
Long Name 2: COMMUNITY ED PREVENTION DEPT

Address 1: 210 NORTH MAIN STREET
Address 2:

City: LONDON
Zip Code: 43140
County: MADI

Contact: JOHN CRUTCHFIELD
Title: DIR
Phone: 7408457321
FAX: 7408457001

Vendor: 1879

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012