Department of Corrections Network Provider Physician Application - gateway sib ok 2026

1. Click ‘Get Form’ to open the Department of Corrections Network Provider Physician Application in the editor.
2. Begin by entering your personal information in the 'General Information' section, including your name, Social Security Number, and National Provider Identifier Number.
3. In the 'Specialty Information' section, specify your profession and primary and secondary specialties.
4. Complete the 'License Information' section by providing details for each state where you hold a professional license, including license numbers and expiration dates.
5. Fill out the 'Insurance Information' section with your current professional liability insurance details. Ensure to attach a copy of your insurance certificate.
6. Provide information about your staff privileges at hospitals in the designated section, listing hospital names and addresses.
7. Complete all required fields under 'Office Information,' ensuring that physical and mailing addresses are accurate for correspondence.
8. Attach all required documents as specified in the application instructions before submitting it via mail or fax to the Department of Corrections.

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