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MPC031918-1Y-1-F Physician Group Application 4 19 Request for Taxpayer Identification Number and Cer

MPC031918-1Y-1-F Physician Group Application 4 19 Request for Taxpayer Identification Number and Cer 2025

MPC031918-1Y-1-F Physician Group Application 4 19 Request for Taxpayer Identification Number and Cer Preview on Page 1

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The document is a Physician Group Contracting Application for Blue Cross, outlining the process for physicians to apply for network participation. It includes instructions on completing the application, requirements for practice members, necessary forms such as the IRS Form W-9, and details about confidentiality and compliance. The application must be submitted with all required information to avoid delays in processing.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (90 Votes)

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