Search results with tag "Businesses and groups general instructions"

CHANGE OF ADDRESS FORM FOR PRACTITIONERS, …

CHANGE OF ADDRESS FORM FOR PRACTITIONERS, BUSINESSES AND GROUPS General Instructions • Pages 3, 4 and 5 of the Change of Address Form must be returned. Red ink, white out and double-sided forms are unacceptable. This form is only for Fee for Service Providers. • Page 3: list the Medicaid Provider Number, NPI (Required, unless NPI exempt ...

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