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T Name Clearinghouse Address 3055 LEBANON PIKE STE 1000 City NASHVILLE State TN Zip 37214 Email PAYERREGISTRATION EMDEON.COM Phone 866.924.4634 Note: VPHP will send enrollment confirmation to the email address above. 2 Billing Agent/Service Information refers to the clearinghouse Billing Agent Name EMDEON Billing Agent Tax ID 133052274 3 Provider Group Information ( W-9 Required) Group/Provider Name Group/Provider Tax ID Group/Provider NPI# (if applicable) 4 Group/Provider.

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