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Get Ia 470-0254 2015-2025
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How to fill out the IA 470-0254 online
This guide provides a comprehensive and user-friendly approach to completing the IA 470-0254 form, essential for Medicaid provider enrollment in Iowa. Follow the steps carefully to ensure a smooth submission process.
Follow the steps to complete the IA 470-0254 online successfully.
- Use the ‘Get Form’ button to access the IA 470-0254 and open it in your preferred document editor.
- Carefully read through the instructions to understand the required information and ensure you have all supporting documentation ready to attach.
- Begin filling out Section A: General Information, marking whether your application is for a new enrollment or a change to your Tax Identification Number.
- Provide your organizational data including the legal name, taxpayer identification number, primary National Provider Identifier, and physical location details.
- Complete the payment information section, specifying your payment method and the relevant addresses.
- If applicable, fill in the pharmacy or independent lab details section with your NCPDP or CLIA numbers.
- Complete Section B with individual or group identifying information. Ensure to fill out a separate copy for each additional group or individual professional being enrolled.
- Provide all required license information, including your Drug Enforcement Agency number, if applicable.
- Review your entries for accuracy and completeness to avoid delays in processing.
- Once you have filled out the form, save the changes, and consider your options to download, print, or share the completed application.
Complete your IA 470-0254 online to ensure timely provider enrollment.
If you need to contact Medicaid member services in Iowa, the address is IA 470-0254, Member Services, P.O. Box 5676, Des Moines, IA 50306. This is where you can seek support for any member-related inquiries or issues. Having the correct address ensures that your questions or concerns reach the right department promptly.
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