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Tmhp 2026
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- Click ‘Get Form’ to open the Provider Information Change Form in the editor.
- Begin by entering the date at the top of the form. Ensure you provide your Nine-Digit Texas Provider Identifier (TPI) and National Provider Identifier (NPI) accurately.
- Fill in your provider name, primary taxonomy code, and any additional TPIs that share the same information. This section is crucial for identifying your practice.
- Complete the physical address section, ensuring it is not a PO Box. Include your telephone number, fax number, city, state, and zip code.
- If applicable, provide your accounting/mailing address along with a copy of the W-9 form if changes are made here.
- Indicate the type of change by checking the appropriate box and provide any necessary comments in the designated field.
- Finally, sign and date the form. Remember that without a signature, processing will be delayed.
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