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Personal Services Insurance Company PO Box 3001 Plymouth Meeting, PA 19462 pH: 610.832.4940 Fax: 610.832.2138 Date (##/##/####) Physician Name Street Address City, State, Zip Claimant: Claim Number:
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Insurer name refers to the name of the insurance company providing coverage.
Insurance policyholders or individuals covered under an insurance policy may need to provide the insurer name.
You can fill out the insurer name by looking at your insurance policy documents or contacting your insurance provider.
The purpose of insurer name is to identify the insurance company providing coverage for a particular policy.
The insurer name should include the full name of the insurance company.
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