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Provider Change of Address Form - Mississippi
Provider Change of Address Form is a legal document that was released by the Mississippi Division of Medicaid - a government authority operating within Mississippi.
FAQ
Q: What is the Provider Change of Address Form?
A: The Provider Change of Address Form is a document used to update the address of a healthcare provider in Mississippi.
Q: Who needs to fill out the Provider Change of Address Form?
A: Healthcare providers in Mississippi who have changed their address need to fill out the form.
Q: Is there a fee for submitting the Provider Change of Address Form?
A: No, there is no fee for submitting the Provider Change of Address Form.
Q: What information is required on the Provider Change of Address Form?
A: The form requires the provider's name, old address, new address, telephone number, and the effective date of the address change.
Q: How long does it take to process the Provider Change of Address Form?
A: The processing time for the form can vary, but it typically takes around 30 days to be completed.
Q: What should I do if I have not received any confirmation after submitting the Provider Change of Address Form?
A: If you have not received any confirmation after submitting the form, you should contact the Mississippi Division of Medicaid to inquire about the status of your address change.
Form Details:
- Released on February 21, 2017;
- The latest edition currently provided by the Mississippi Division of Medicaid;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Mississippi Division of Medicaid.
Download Provider Change of Address Form - Mississippi
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