UPI (Provider ID): 11200
Change Report (if Any):

Short Name: HMIH-COLS OPT

Long Name 1: HMIH COLUMBUS OUTPATIENT
Long Name 2: CLINIC

Address 1: 1430 SOUTH HIGH STREET
Address 2:

City: COLUMBUS
Zip Code: 43207
County: FRAN

Contact: WILLIE FELTS
Title: CFO
Phone: 6144499664
FAX: 6144499620

Vendor: 11199

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016