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PRINTED: 02/27/2020
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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What is provider number 15g667?
Provider number 15g667 is a unique identifier given to a specific provider for tax reporting purposes.
Who is required to file provider number 15g667?
Any entity or individual that makes payments to the provider associated with number 15g667 is required to file.
How to fill out provider number 15g667?
Provider number 15g667 should be filled out with accurate payment information and details of the provider.
What is the purpose of provider number 15g667?
The purpose of provider number 15g667 is to track and report payments made to the specific provider for tax purposes.
What information must be reported on provider number 15g667?
Information such as payment amount, date, and recipient details must be reported on provider number 15g667.
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