MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 3188
Change Report (if Any):

Short Name: COLUMBUS AREA

Long Name 1: COLUMBUS AREA INC
Long Name 2:

Address 1: 1515 EAST BROAD STREET
Address 2:

City: COLUMBUS
Zip Code: 43205
County: FRAN

Contact: CASSANDRA ELLIS
Title: CFO
Phone: 6142520711
FAX: 6142526181

Vendor: 3188

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 01/09/2012

File Produced: 19MAY2012