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Please mail or fax to: Eden 220 Burnham St., South Windsor, CT 06074 Phone: 8882557293 Fax: 8602890055 Registration Form Please type or print. Practice Name: Contact Name: Address: Suite: City: State:
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Provider 2 provider 3 refers to the process of one service provider transferring specific information or services to another service provider.
The service providers involved in the transfer of information or services are required to file provider 2 provider 3.
Provider 2 provider 3 is typically filled out by providing detailed information about the transferred services or information, including the sender and recipient details.
The purpose of provider 2 provider 3 is to ensure that the transfer of services or information between service providers is properly documented and accounted for.
Information such as the nature of services transferred, the date of transfer, sender and recipient details, and any relevant identifiers must be reported on provider 2 provider 3.
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