MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 6723
Change Report (if Any):

Short Name: SOUTHEAST INC

Long Name 1: SOUTHEAST INC
Long Name 2:

Address 1: 16 WEST LONG STREET
Address 2:

City: COLUMBUS
Zip Code: 43215
County: FRAN

Contact: STEVEN ATWOOD
Title: CFO
Phone: 6142250980
FAX: 6142250986

Vendor: 6723

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 03/20/2012

File Produced: 19MAY2012