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Practice Name Fax Office Phone Email Street Address County City/ST/Zip Office accessible by public transportation Yes Handicapped parking Yes Off street parking Yes Federal TIN/EIN Treat disabled adults Yes TIN/EIN Name National Provider Identifier NPI include a copy of your National Plan and Provider Enumeration System NPI Entity Type 2 NPPES confirmation s NPI Entity Type 1 Which is to be used for your Federal 1099 Tax Requirements please circle TIN/EIN Will you accept new patients from our...
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Who needs credentialing application110906doc?
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Individuals or professionals in specific fields who require credentialing.
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Anyone seeking approval, certification, or recognition in a particular field.
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What is credentialing application110906doc?
Credentialing application110906doc is a document used to apply for credentials or certification in a specific field, typically in healthcare.
Who is required to file credentialing application110906doc?
Healthcare professionals or providers who are seeking credentials or certification in their field are required to file credentialing application110906doc.
How to fill out credentialing application110906doc?
Credentialing application110906doc should be filled out completely with accurate information regarding the applicant's education, experience, and qualifications.
What is the purpose of credentialing application110906doc?
The purpose of credentialing application110906doc is to assess the qualifications and credentials of healthcare professionals or providers to ensure they meet the standards for certification.
What information must be reported on credentialing application110906doc?
Information such as education background, work experience, certifications, licenses, and any disciplinary actions must be reported on credentialing application110906doc.
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