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Get Medicare Part B Forms Printable

E Part B Payment Recovery P.O. Box 8811 Marion, IL 62959-0910 Provider/Supplier Name Address Michigan WPS Medicare Part B Payment Recovery P.O. Box 5511 Marion, IL 62959-0945 City, State, Zip Code PTAN Tax Identification Number (TIN) Contact Name Amount of Check: Telephone Number Refund Check #: Check Date: Did Medicare Request This Refund? Yes No If Yes , indicate the Accounts Receivable Number (this number is on your letter; please include a copy of your letter) OIG Reporting R.

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