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KPMG LLP Complex 255210 LITTLE COMPANY OF MARY Provider CCN: 140179In Lieu of Form CMS255210Period : From: 07/01/2015 To: 06/30/2016Run Date: 11/23/2016 Run Time: 08:06 Version: 2016.05 (11/15/2016)HOSPITAL
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How to fill out provider ccn 14-0179
How to fill out provider ccn 14-0179
01
To fill out provider ccn 14-0179, follow these steps:
02
Start by providing your personal information such as your name, address, phone number, and email address.
03
Next, provide your organization's details including the name, address, and contact information.
04
Indicate the type of provider you are (individual, group, or organization) and provide any necessary identification numbers.
05
Specify the services you offer and the areas you serve.
06
Provide information on any certifications or accreditations you have.
07
Include any additional supporting documentation or attachments required.
08
Review the form for completeness and accuracy before submitting it.
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Finally, sign and date the form to certify the information provided.
Who needs provider ccn 14-0179?
01
Provider ccn 14-0179 is needed by healthcare providers who wish to participate in certain programs or services. This form is often required for enrollment or registration purposes and helps establish the provider's qualifications and eligibility to provide services.
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What is provider ccn 14-0179?
Provider ccn 14-0179 is a unique identification number assigned to a healthcare provider.
Who is required to file provider ccn 14-0179?
Healthcare providers are required to file provider ccn 14-0179 as part of their reporting obligations.
How to fill out provider ccn 14-0179?
Provider ccn 14-0179 can be filled out electronically through the designated online portal or manually on the paper form provided.
What is the purpose of provider ccn 14-0179?
The purpose of provider ccn 14-0179 is to accurately identify and track healthcare providers for billing and reporting purposes.
What information must be reported on provider ccn 14-0179?
Provider ccn 14-0179 typically requires information such as provider name, address, contact details, and specialty.
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