Ahcccs address change 2026

1. Click ‘Get Form’ to open the ahcccs address change form in the editor.
2. Begin by entering your name in the designated fields for Last, First, and Middle Initial. Ensure accuracy as this information is crucial.
3. Fill in your Social Security Number and Gender by selecting either Male or Female. This information is necessary for identification purposes.
4. Provide your AHCCCS Provider ID# and NPI #. If you are adding additional information, check the appropriate box.
5. Complete the Correspondence Address section with your street address, city, state, and zip code. Include business and emergency phone numbers.
6. For each Pay-To Address section (Site 01, Site 02, Site 03), repeat the process of filling out street lines, city, state, zip code, and contact numbers.
7. Finally, affirm that all provided information is true by signing the form. Ensure that it is signed by an authorized signor on file with AHCCCS before submission.

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