Network Provider Data Change Requests - Martin's Point Health Care

Select a Mode

	Update practice demographic information, including phone/fax number, address, or billing information Close an existing location Add a new location to an existing group
	Update provider demographic information, including name change, specialty change or addition, panel status or telehealth availability. Terminate a provider from a location or practice
	Add a new provider to your practice Add an existing provider to an additional location
	Check the status of a previously submitted request A tracking number is required