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 Group Information Packet 2018-2023

Group Information Packet 2018-2023

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Record ID to your organization and to assign BCBSTX internal Individual Provider Record IDs for the providers affiliated with your organization. Please fully complete all applicable information in its entirety and forward the completed packet along with the State License of each provider and the entity’s completed W-9 to BCBSTX Provider Administration by fax (preferred method) or by mail. The fax number and mailing address are indicated below. A. Provider of Service Information – Please...
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