Change Request

Martin's Point Health Care


New Provider Request

Add a Provider (or Specialty) at a Location

  = Required Information

Provider Information

Specialty 1

Select a provider type to view the specialties that require credentialing in order to be shown in our provider directory. If the specialty is not listed below, credentialing is not required and advance information about the provider is not needed.
Please note that contracted providers who are not credentialed will be added to our system based on information submitted with claims.

Specialty 2 (if applicable)