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PAYER ID: SKCO0 SUBMITTER ID: 100548 Eden Claims Provider Information Form *This form is to ensure accuracy in updating the appropriate account 1 Provider Organization Practice/ Facility Name Provider
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Submitter id 100548 is a unique identifier assigned to a specific individual or entity submitting information.
The individual or entity to whom the submitter id 100548 is assigned is required to file it.
Submitter id 100548 must be filled out by providing the required information accurately and completely in the designated fields.
The purpose of submitter id 100548 is to uniquely identify the submitter of the information.
The information that must be reported on submitter id 100548 includes specific details related to the submission.
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