MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 8369
Change Report (if Any):

Short Name: ATHE-MEIG ED CN

Long Name 1: ATHENS MEIGS EDUCATIONAL
Long Name 2: SERVICE CENTER

Address 1: 320 EAST MAIN STREET
Address 2:

City: POMEROY
Zip Code: 45769
County: MEIG

Contact: JOHN COSTANZO
Title:
Phone: 7409923883
FAX: 7409926291

Vendor: 8369

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 19MAY2012