UPI (Provider ID): 1512
Change Report (if Any):

Short Name: EDWIN SHAW HOSP

Long Name 1: EDWIN SHAW HOSPITAL FOR
Long Name 2: REHABILITATION

Address 1: 1621 FLICKINGER RD
Address 2:

City: AKRON
Zip Code: 443124495
County: SUMM

Contact: RANDY VIPPERMAN
Title: PGDIR
Phone: 3307841271
FAX: 3307847270

Vendor: 1512

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016