Get Dea Number Form - Ncdhhs

Filling out the DEA Number Form - Ncdhhs online is an essential process for healthcare providers who prescribe controlled substances. This guide provides clear and supportive instructions to assist you in accurately completing this form.

Follow the steps to successfully complete the DEA Number Form - Ncdhhs.

1. Press the ‘Get Form’ button to access the DEA Number Form - Ncdhhs and open it in the online editor.
2. Begin by entering your provider name in the appropriate field. Ensure that the name is spelled correctly as this will be used for identification purposes.
3. Next, input your Medicaid provider number. This number should be clearly available on your Medicaid documentation.
4. Fill out your street address accurately. Include any necessary details such as apartment or suite numbers.
5. Select the state where you practice from the dropdown menu. This action ensures that your information complies with local regulations.
6. Type in your city of practice. This helps to localize your practice location for relevant authorities.
7. Provide your telephone number. Make sure to include the area code and format the number correctly for clarity.
8. Enter your DEA number in the designated field. This is critical for identifying your authority to prescribe controlled substances.
9. If applicable, you may also input your prescriber Medicaid identification number instead of the DEA number.
10. Finally, ensure that you complete the zip code field to provide your full address information.
11. Once all fields are accurately filled, you can save your changes, download the completed form, print it for your records, or share it as needed.

Complete your documents online today to ensure compliance and maintain your prescribing authority.