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Get Ia Dhs 470-0254 2013

Signed Provider Agreement. We appreciate your effort in providing this information and your participation in the Iowa Medicaid Program. Thank you! Questions in completing this application: Iowa Medicaid Enterprise Provider Services Unit at (800) 338-7909 or (515) 256-4609. Section A: General Information Practice Information 1. Legal Name (as it appears on your income tax return) 2. Taxpayer Identification Number (TIN): Enter the nine-digit Federal Employer Identification Number (FEIN) of the b.

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