UPI (Provider ID): 8496
Change Report (if Any):

Short Name: SIGNATURE-ASHTA

Long Name 1: SIGNATURE HEALTH INC
Long Name 2:

Address 1: 4200 PARK AVENUE
Address 2:

City: ASHTABULA
Zip Code: 44004
County: ASHT

Contact: JONATHAN LEE
Title: DIR
Phone: 4409928552
FAX: .

Vendor: 6857

Reports Status: CLAIMS/BH

MACSIS Last Update Date: 04/13/2012

File Produced: 14JUL2016