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Division of Mental Health and Addiction 402 W. WASHINGTON STREET, ROOM W353 INDIANAPOLIS, IN 46204-2739 317-232-7800 FAX: 317-233-3472 DMCA Youth Home & Community-Based Wraparound Services (HUBS)
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What is provider demographic instruction form?
The provider demographic instruction form is a document used to collect and update demographic information about a healthcare provider.
Who is required to file provider demographic instruction form?
Healthcare providers are required to file the provider demographic instruction form.
How to fill out provider demographic instruction form?
The provider demographic instruction form can be filled out online or by submitting a paper form with the required information.
What is the purpose of provider demographic instruction form?
The purpose of the provider demographic instruction form is to ensure accurate and up-to-date information about healthcare providers.
What information must be reported on provider demographic instruction form?
The provider demographic instruction form typically requires information such as name, address, contact information, specialty, and practice location.
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