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Get CA DHCS 6202 2013

Ider and Biller Application/Agreement (DHCS 6153, rev. 03/12), available on the Medi-Cal website at www.medi-cal.ca.gov by clicking the ““Forms” link in the “Featured” area, and then selecting the form under the “Billing” category. Provider Enrollment Division Enclosures (01/13) Provider Enrollment Division MS 4704 P.O. Box 997412, Sacramento, CA 95899-7412 (916) 323-1945 Internet Address: www.dhcs.ca.gov/provgovpart/Pages/PED.aspx State of California—Health and Human Servi.

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