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PROVIDER CCN: 140281 NORTHWESTERN MEMORIAL HOSPITAL PERIOD FROM 09/01/2011 TO 08/31/2012KPMG LLP COMPLEX MICRO SYSTEM IN LIEU OF FORM CMS255210 (08/2011)VERSION: 2012.11 01/28/2013 14:42HOSPITAL AND

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How to fill out provider ccn 14-0281

01

To fill out the provider ccn 14-0281 form, follow these steps:

02

Start by entering the required provider information such as name, address, and contact details.

03

Provide the CCN (Control Code Number) which is a unique identifier for the provider.

04

Specify the type of services being offered by the provider.

05

Fill in the relevant financial information, including billing details and payment terms.

06

Attach any necessary supporting documentation, such as licenses, certifications, or agreements.

07

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08

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Submit the filled-out provider ccn 14-0281 form to the appropriate authority or organization.

Who needs provider ccn 14-0281?

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Anyone who is involved in providing services and needs to be recognized by the authority or organization requiring the provider ccn 14-0281 may need this form. This may include healthcare providers, service contractors, government agencies, or any other entity that requires official registration or recognition.

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