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  • Wa Credential Status Change Form 2020

Get Wa Credential Status Change Form 2020-2025

DOH 505-089 February 2016 Page 1 of 3 Qualifications of Personnel for Moderate Complexity Testing Director check only one FF 1. Medical Test Site MTS Credentialing P. O. Box 47877 Olympia WA 98504-7877 360-236-4700 Credential Status Change Form Use this form for address phone number fax number email or facility name or contact changes to individual credentials. Send the completed change form to the address listed above. Complete pages two and three only if you are changing the director of a categorized or accredited license. Your Information MTS Name Effective date of change MTS License Clinical Laboratory Improvement Amendments CLIA Type of Change to MTS Listed Above Address Change current address c Mailing c Physical c Both New Address City New phone enter 10 digit State Zip Code New fax enter 10 digit Facility Name change new name of MTS Name of new laboratory contact Email address Name of new microbiology contact Name of new cytology contact Do not complete pages two and three unle....

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232