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Oklahoma Department of Rehabilitation ServicesDOCDepartment of Corrections OklahomaNETWORK PROVIDER ADDITIONAL LOCATION FORM Name: (Last) (First) (Middle) NPI Number: Primary Specialty:(License Type)Secondary
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How to fill out provider additonal location form
How to fill out provider additonal location form
01
Start by downloading the provider additional location form from the official website.
02
Fill out the basic information section, including the provider's name, contact information, and primary location details.
03
Next, provide the address of the additional location you want to add.
04
If applicable, provide any specific instructions or notes for the additional location.
05
Make sure to review all the information entered for accuracy before submitting the form.
06
Once the form is complete, submit it through the designated channel or to the corresponding department for processing.
Who needs provider additonal location form?
01
The provider additional location form is needed by healthcare providers or organizations who have multiple locations and want to officially add an additional location to their profile.
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What is provider additional location form?
The provider additional location form is a document used to report additional locations where healthcare services are provided by a healthcare provider.
Who is required to file provider additional location form?
Healthcare providers who operate in multiple locations or have additional service sites are required to file the provider additional location form.
How to fill out provider additional location form?
To fill out the provider additional location form, complete all required fields including the provider's name, NPI number, address of the additional location, and any other relevant information as specified in the form instructions.
What is the purpose of provider additional location form?
The purpose of the provider additional location form is to ensure that all locations where healthcare services are offered are registered and accounted for, which helps in accurate billing and regulatory compliance.
What information must be reported on provider additional location form?
Information that must be reported includes the provider's name, National Provider Identifier (NPI), addresses of additional locations, types of services provided at those locations, and any pertinent licensing information.
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