Tmhp 2026

1. Click ‘Get Form’ to open the Provider Information Change Form in the editor.
2. 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.
3. 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.
4. Complete the physical address section, ensuring it is not a PO Box. Include your telephone number, fax number, city, state, and zip code.
5. If applicable, provide your accounting/mailing address along with a copy of the W-9 form if changes are made here.
6. Indicate the type of change by checking the appropriate box and provide any necessary comments in the designated field.
7. Finally, sign and date the form. Remember that without a signature, processing will be delayed.

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