Download and complete the Non-participating Setup Request form
Email the form to: [email protected]
Or mail to:
Provider Data Operations
PO Box 982809
El Paso, TX 79998-2809
Please allow up to 90 days for completion of this process.
Modified on: Fri, 7 Jul, 2023 at 4:07 PM
Download and complete the Non-participating Setup Request form
Email the form to: [email protected]
Or mail to:
Provider Data Operations
PO Box 982809
El Paso, TX 79998-2809
Please allow up to 90 days for completion of this process.
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