UPI (Provider ID): 12484
Change Report (if Any):

Short Name: OHIO CLINIC PSY

Long Name 1: OHIO CLINIC FOR PSYCHIATRY
Long Name 2:

Address 1: 880 GREENLAWN AVENUE
Address 2:

City: COLUMBUS
Zip Code: 43223
County: FRAN

Contact: ROXANNE JIVIDEN
Title: CEO
Phone: 6144447916
FAX: 6144447924

Vendor: 12483

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 06/27/2012

File Produced: 14JUL2016