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PRINTED: 01/31/2020
FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA
IDENTIFICATION
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How to fill out provider number 155269
How to fill out provider number 155269
01
Obtain the necessary forms from the relevant organization.
02
Fill out all required personal information, such as name, address, and contact details.
03
Provide any business information, such as the name of your organization and its purpose.
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Include any required supporting documentation, such as proof of licensure or certification.
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Who needs provider number 155269?
01
Healthcare providers, such as doctors, nurses, and therapists, who are seeking to bill insurance companies for services rendered.
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What is provider number 155269?
Provider number 155269 is a unique identifier assigned to a specific healthcare provider or facility.
Who is required to file provider number 155269?
Healthcare providers and facilities who are enrolled in a healthcare program that requires the use of provider numbers are required to file provider number 155269.
How to fill out provider number 155269?
Provider number 155269 can be filled out on the appropriate forms provided by the governing healthcare program or agency.
What is the purpose of provider number 155269?
The purpose of provider number 155269 is to accurately identify and track healthcare providers and facilities for billing, regulatory, and quality assurance purposes.
What information must be reported on provider number 155269?
Provider number 155269 may require reporting of provider information such as name, address, contact information, services provided, and billing details.
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