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Provider Update Request Form Practice address changeling address change (Must submit a W9)Add locational provider to existing groupTerminationTax ID change (Must submit a W9) ResignedTermination Reasons:RetiredClosed
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What is practice address change?
Practice address change is the process of updating the location where a business or professional practice is physically located.
Who is required to file practice address change?
Any business or professional practice that changes its physical location is required to file a practice address change.
How to fill out practice address change?
To fill out a practice address change, the business or professional practice must complete the necessary forms provided by the appropriate regulatory agency and submit them with the updated address information.
What is the purpose of practice address change?
The purpose of practice address change is to ensure that all relevant parties are aware of the new location of the business or professional practice.
What information must be reported on practice address change?
The practice address change form typically requires the business or professional practice to provide their old address, new address, contact information, and any relevant license numbers.
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