MACSIS Provider (PROVF) Summary Sheet

UPI (Provider ID): 2466
Change Report (if Any):

Short Name: HUMADAOP-CUYA

Long Name 1: HUMADAOP INC
Long Name 2:

Address 1: 3305 WEST 25TH STREET
Address 2:

City: CLEVELAND
Zip Code: 44109
County: CUYA

Contact: CARLOS IVAN RAMOS
Title: DIR
Phone: 2164591222
FAX: 2164592696

Vendor: 2466

Reports Status: CLAIMS/NO

MACSIS Last Update Date: 12/16/2011

File Produced: 14JUL2016