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Get Group/Organization And Sole Proprietor Applicants

Ing your Tax Identification Number with the legal business name/legal name as noted in Section 1 of the Mississippi Medicaid Provider Enrollment Application. Individual Applicants The name on the W-9 should match the legal name as noted in Section 1 of the Mississippi Medicaid Provider Enrollment Application. W-9 Form (Rev. December 2014) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send t.

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