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Leon Health Plan Practice Address Change Request Steps for Submission: 1. Complete the Practice address Change Form with the most current information and attach a W9 if applicable. 2. Email the form

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How to fill out practice address change request

01

Obtain the practice address change request form from the appropriate authority.

02

Fill out the form with the current practice address and the new practice address.

03

Provide any necessary supporting documentation, such as proof of ownership or lease agreement for the new practice address.

04

Submit the completed form and supporting documentation to the designated office or department.

05

Wait for confirmation of the address change request to be processed.

Who needs practice address change request?

01

Healthcare providers who are relocating their practice to a new address.

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What is practice address change request?

Practice address change request is a formal request to update the address where a practice is located.

Who is required to file practice address change request?

Healthcare professionals or organizations who have changed the location of their practice.

How to fill out practice address change request?

The request can typically be filled out online or submitted through a specific form provided by the relevant licensing or regulatory body.

What is the purpose of practice address change request?

The purpose is to ensure accurate records and communication regarding the location of a healthcare practice.

What information must be reported on practice address change request?

The new address of the practice, effective date of the change, and any supporting documentation required.

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