UPI (Provider ID): 12849
Change Report (if Any):

Short Name: SIGNATURE-MAPLE

Long Name 1: SIGNATURE HEALTH INC
Long Name 2:

Address 1: 5410 TRANSPORTATION BLVE
Address 2: UNIT F

City: GARFIELD HEIGHTS
Zip Code: 44125
County: CUYA

Contact: JONATHAN LEE
Title: PRES
Phone: 2166636100
FAX: 2166637113

Vendor: 6857

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 04/16/2012

File Produced: 14JUL2016