MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 10250
Change Report (if Any):

Short Name: BRIDGEWAY-11422

Long Name 1: BRIDGEWAY INC
Long Name 2:

Address 1: 11422 LORAIN AVENUE
Address 2:

City: CLEVELAND
Zip Code: 44111
County: CUYA

Contact: PAT FAHEY
Title: PGMGR
Phone: 2168899640
FAX: 2167412198

Vendor: 10509

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016