UPI (Provider ID): 1073
Change Report (if Any):

Short Name: CLEVE HLTH SMIT

Long Name 1: CLEVELAND DEPARTMENT OF HEALTH
Long Name 2:

Address 1: J GLEN SMITH HEALTH CENTER
Address 2: 11100 SAINT CLAIR AVENUE

City: CLEVELAND
Zip Code: 44108
County: CUYA

Contact: DAVID GRETICK
Title: PGDIR
Phone: 2166643891
FAX: .

Vendor: 10333

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 12/22/2011

File Produced: 14JUL2016