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DateProvider Clinic or Practice Name Street Address City, State, Zippier Provider: The Patient Protection and Affordable Care Act (PACA) and Title 42 Code of Federal Regulations (CFR) 455.414 require
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What is Clinic or Practice Name Form?

The Clinic or Practice Name is a Word document that should be submitted to the specific address to provide certain information. It has to be completed and signed, which may be done manually in hard copy, or with the help of a certain solution such as PDFfiller. This tool helps to fill out any PDF or Word document directly in your browser, customize it according to your purposes and put a legally-binding e-signature. Once after completion, you can send the Clinic or Practice Name to the appropriate person, or multiple ones via email or fax. The template is printable too thanks to PDFfiller feature and options presented for printing out adjustment. Both in digital and in hard copy, your form should have a organized and professional look. It's also possible to save it as the template for further use, without creating a new blank form from the beginning. All that needed is to customize the ready document.

Template Clinic or Practice Name instructions

Before start to fill out Clinic or Practice Name Word form, remember to have prepared all the required information. It is a mandatory part, since some typos may cause unwanted consequences from re-submission of the whole entire and finishing with deadlines missed and you might be charged a penalty fee. You have to be really observative filling out the figures. At first glimpse, it might seem to be very simple. But nevertheless, it is simple to make a mistake. Some people use some sort of a lifehack keeping their records in a separate document or a record book and then insert it into documents' temlates. In either case, come up with all efforts and provide true and solid information in Clinic or Practice Name word template, and doublecheck it while filling out all required fields. If you find a mistake, you can easily make some more corrections when using PDFfiller editor and avoid blowing deadlines.

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Clinic or practice name refers to the official name of a medical facility or healthcare practice.
Healthcare providers or medical professionals who own or operate a clinic or practice are required to file the clinic or practice name.
Clinic or practice name can be filled out on official forms provided by regulatory authorities or online platforms designated for healthcare registration.
The purpose of clinic or practice name is to identify and distinguish a specific healthcare facility or practice from others.
The information that must be reported on clinic or practice name includes the official name, address, contact details, and any relevant licensing or accreditation information.
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