Get the free Practitioner Identification Number Request Form... - humanservices arkansas
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Division of Medical Services Gainwell Technologies Provider Enrollment Unit P.O. Box 8105, Little Rock, AR 722038105 P: (501) 3762211 WATS: (800) 4574454 F: (501) 3740746Change of Ownership Information
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How to fill out practitioner identification number request
How to fill out practitioner identification number request
01
Obtain the practitioner identification number request form from the appropriate agency or organization.
02
Fill out all required fields on the form, including personal information and any relevant professional information.
03
Provide any necessary supporting documentation, such as proof of certification or licensure.
04
Double-check the form for accuracy and completeness before submitting it.
05
Submit the completed form and any supporting documentation to the appropriate agency or organization as instructed.
Who needs practitioner identification number request?
01
Healthcare professionals, such as doctors, nurses, and other medical practitioners, who need to obtain a unique identifier for billing and reimbursement purposes.
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What is practitioner identification number request?
The practitioner identification number request is a form used to apply for an identification number for healthcare practitioners.
Who is required to file practitioner identification number request?
Any healthcare practitioner who needs an identification number to practice legally.
How to fill out practitioner identification number request?
The form typically requires personal information, education and training details, and proof of professional licensure.
What is the purpose of practitioner identification number request?
The purpose is to accurately identify and track healthcare practitioners for regulatory purposes.
What information must be reported on practitioner identification number request?
Personal details, professional qualifications, and any relevant certifications or licenses.
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