Get July 14, 2006 Name Address City/state/zip Dear Provider: The ...

This guide provides clear instructions on how to complete the July 14, 2006 Name Address City/State/Zip Dear Provider: The National Provider Identifier Submission Form online. Follow these steps to ensure your submission is accurate and complete.

Follow the steps to successfully fill out the form online.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. In Section 1, enter your provider general information. This includes your last name, first name, middle initial, degree or title, tax identification number, and existing BCBS provider number(s). Ensure all fields are filled out accurately.
3. In Section 2, record your 10-digit National Provider Identifier (NPI). This should be taken directly from the confirmation letter you received from the enumerator. Remember, you must submit a copy of this letter with your form.
4. In Section 3, provide your primary office address information. Validate that the address, phone number, fax number, and provider email address are correct and add any missing details.
5. In Section 4, fill in the contact information for the individual completing the form. This includes their name, phone number, fax number, and email address.
6. After completing all sections, save your changes, and choose the option to download, print, or share the completed form as needed.

Complete your documents online today to ensure timely processing.