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ADDITIONAL PRACTICE LOCATION FORM ATTACHMENT 3A If you are adding additional provider numbers to an existing registration, please indicate the provider number this should be linked to. Use the Provider
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How to fill out additional practice location form:

01
Start by entering your personal information, including your name, contact information, and any required identification numbers.
02
Next, specify the type of practice location you are adding and provide the necessary details such as address, phone number, and any other relevant information.
03
If there are multiple practice locations, make sure to list each location separately, following the same format.
04
If required, provide any supporting documents or attachments that may be necessary to validate the additional practice location.
05
Review the form for accuracy and completeness before submitting it.

Who needs additional practice location form:

01
Healthcare professionals who are expanding their practice to include additional locations may need to fill out the additional practice location form.
02
Medical practices or healthcare facilities that are opening new branches or satellite locations may also require this form.
03
Insurance providers or regulatory authorities may request this form to ensure that healthcare services are being provided in compliant locations.
Note: It is recommended to consult the specific guidelines and requirements provided by the relevant organization or regulatory body when filling out the additional practice location form.
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Additional practice location bformb is a form used to report any additional physical locations where a healthcare provider practices outside of their primary practice location.
Healthcare providers who practice in multiple physical locations are required to file the additional practice location bformb.
To fill out the additional practice location bformb, healthcare providers must provide details of the additional practice locations, including address, contact information, and any services provided at that location.
The purpose of the additional practice location bformb is to ensure that all practice locations of a healthcare provider are properly documented and regulated.
Healthcare providers must report the address, contact information, and services provided at each additional practice location on the bformb.
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