UPI (Provider ID): 1674
Change Report (if Any):

Short Name: MARYMOUNT

Long Name 1: MARYMOUNT HOSPITAL
Long Name 2:

Address 1: 12300 MCCRACKEN ROAD
Address 2:

City: GARFIELD HEIGHTS
Zip Code: 44125
County: CUYA

Contact: WILLIAM KECKEN
Title: VP OP
Phone: 2165810500
FAX: 2165878871

Vendor: 1674

Reports Status: NO CLAIMS/

MACSIS Last Update Date: 11/29/2011

File Produced: 14JUL2016