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Attach additional sheets if necessary to list all providers. Provider Name NPI/API Group NPI/API 10/07/2016 pv09/29/2014 1/2 2/2. List each provider s name 10-digit NPI/API and the 10-digit NPI/API of the group that provider is associated with when applicable. 0 or higher Which claim form do you use ADA CMS-1500 UB How many providers from your practice/business/facility will be submitting claims under this Payerpath account Primary User first and last name Fax E-mail Secondary User first and...
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What is fa-39 form?
The FA-39 form is a tax form used to report certain financial information to the government.
Who is required to file fa-39 form?
Individuals or businesses meeting specific criteria outlined by the government are required to file the FA-39 form.
How to fill out fa-39 form?
The FA-39 form can be filled out manually or electronically, following the instructions provided by the government.
What is the purpose of fa-39 form?
The purpose of the FA-39 form is to ensure that individuals or businesses report accurate financial information to the government.
What information must be reported on fa-39 form?
The FA-39 form typically requires information such as income, expenses, deductions, and other financial details.
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