CSIS PROVIDER (PROVF) SUMMARY SHEET

MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 8355
Change Report (if Any):

Short Name: KETTERING-PREVE

Long Name 1: KETTERING PARKS RECREATION AND
Long Name 2: CULTURAL ARTS DEPARTMENT

Address 1: 3600 SHROYER ROAD
Address 2:

City: KETTERING
Zip Code: 45429
County: MONT

Contact: SHEILA RUSSELL
Title:
Phone: 9372962454
FAX: 9372963242

Vendor: 8355

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012 19MAY2012