Participating in-network providers can update their contact information, NPI number, and Tax Identification Number (TIN) below.
Complete the online form below.
Submit additional documents, as required, (e.g., W9, licensure) using one of these methods:
Secure Fax : 214-390-2139
Please allow ten (10) business days for your changes to update in our system.
If you have questions, please call the Provider Support Team at 888.806.3400
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Please complete this form if you are submitting these changes on behalf of a provider.