MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 4836
Change Report (if Any):

Short Name: CONTACT-CRAW

Long Name 1: CONTACT INC
Long Name 2:

Address 1: PO BOX 631
Address 2:

City: BUCYRUS
Zip Code: 448200631
County: CRAW

Contact: JUDITH STRENG
Title: EX DR
Phone: 4195629099
FAX: 4195326855

Vendor: 4836

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012