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Form OHP3105 Provider Enrollment Attachment - Independent Radiology - Oregon
What Is Form OHP3105?
This is a legal form that was released by the Oregon Health Authority - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the OHP3105 Provider Enrollment Attachment?A: The OHP3105 Provider Enrollment Attachment is a form used for provider enrollment in Oregon Health Plan (OHP) for Independent Radiology services.
Q: Who is this form for?A: This form is for Independent Radiology providers who wish to enroll in the Oregon Health Plan (OHP).
Q: What information is required in the form?A: The form requires information about the provider's business, contact information, services provided, and other enrollment details.
Q: What is the purpose of this form?A: The purpose of this form is to collect necessary information from Independent Radiology providers in order to enroll them in the Oregon Health Plan (OHP).
Form Details:
- Released on May 1, 2016;
- The latest edition provided by the Oregon Health Authority;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form OHP3105 by clicking the link below or browse more documents and templates provided by the Oregon Health Authority.
Download Form OHP3105 Provider Enrollment Attachment - Independent Radiology - Oregon
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