Note: For Entity Type 2 applications, the Authorized Official will sign in Section 4B. Note: For Entity Type 1 applications, the Provider will sign in Section 4A. In Section 4A or 4B Certification Statement, the Provider/Authorized Official will sign the application.If you are making an update to Section 3C Other Provider Identification Numbers or Section 3D Provider Taxonomy Code, be sure to indicate if the information is to be added to the NPI record or if it is to replace the information that is currently in the NPI record. Complete the sections that need to be updated.Provide the correct NPI on the line below the Change of Information box. In Section 1A Reason For Submittal of this Form, select the Change of Information box.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |