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Get IA IAMSS Renewal Membership Form 2019-2024

: Fax Number: Email Address: Accredited by (check any that apply): TJC DNV NCQA State Surveyed Only URAC Other: Specify Not applicable Best describes your role/setting: Medical Staff Credentialing Critical Access Hospital / Hospital (Bed size: ) CVO Practitioner Clinic / Office Managed Care Provider Enrollment Other: Specify (check all that apply) Credentialing Software Used (if applicable): NAMSS Member Certified Provider Credential.

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