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Get and Sign Form a 2210 Ohio Department of Jinsurance Credentialing Form 2001-2022

Get and Sign Form a 2210 Ohio Department of Jinsurance Credentialing Form 2001-2022

Use a form standardized credentialing 2001 template to make your document workflow more streamlined.

Dates, limits and provider’s name Copy of Board Certification Certificate, if applicable Copy of certificate or letter certifying formal post-graduate training Copy of Curricula Vita/Resume Include work history. (Not accepted as a substitute for completion of application.) Copy of ECFMG Certificate (if applicable) Copy of W-9 for verification of each tax identification number used Copy of certificates for conducting x-ray and/or laboratory services (if applicable) Copy of Workers Compensation...
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