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Provider/Organization Name: Provider Name: Title: License #: Tax ID / Social Security #: * number that will be used to submit electronic claims NPI # (National Provider Identification): Group NPI
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How to fill out providerorganization name provider name
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To fill out the provider organization name, follow these steps:
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Anyone who is involved in official documentation or transactions related to a provider organization needs to provide the organization name and the provider name. This may include:
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