Get 1649431420 Jason Thomas 1649431420 Jason Thomas

Filling out the 1649431420 JASON THOMAS form online is an essential task for health care providers to ensure their information is correctly documented. This guide provides a clear and supportive step-by-step approach to help you complete this process efficiently.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Enter the 10-position all-numeric identification number assigned to you. This number uniquely identifies you as a health care provider.
3. Select the code for your provider type. If you are an individual health care provider, choose '1'. If you represent a non-person entity, select '2'.
4. Indicate whether you are a sole proprietor by selecting 'Yes' or 'No'. Ensure that you understand the implications of being a sole proprietor.
5. Fill in your legal last name as it appears in official records, ensuring it matches the name on file with the Social Security Administration.
6. Fill in your first name. This should also conform to the name on file with the Social Security Administration.
7. Provide any credentials or professional abbreviations held by you, such as 'MD' or 'RNFA'.
8. Complete the business mailing address, including the first and second lines, city, state, postal code, and country code.
9. Include your business mailing address telephone number and fax number.
10. Enter the business practice location address, ensuring accuracy in the first line, second line, city, state, postal code, and country code.
11. Provide the phone and fax numbers associated with your business practice location.
12. Record the date you were assigned a unique identifier and the last update date of your record.
13. If applicable, indicate your gender, ensuring the gender code reflects the information accurately.
14. Select your health care provider taxonomy code and provide your license number along with the state code where licensed.
15. If there are any other provider identifiers, make sure to list them with details on the type and issuer.
16. Review all entered information for accuracy before finalizing. Once you are satisfied, save your changes, download, print, or share the form as needed.

Complete your documents online now for efficient management.