Maine Medical - Provider

Status

Close Date^*

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National Provider ID^*

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Facility ID^*

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OLD Provider #

Claim File Format^*

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Provider Name^*

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Address

City

Phone

Fax

State/Province^*

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Postal (9-digits only)^*

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Federal Tax Number- EIN^*

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Residents have individual service rate

Default Code

Bill Type^*

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METPID000438

RCCA

100140000

RCC Business Services

2077950663