Provider Account Application - Independent Medical Examiner (IME)

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Título

Provider Account Application - Independent Medical Examiner (IME)

(Un formulario electrónico)- 757 KB PDF)
Descripción

In order to do independent medical exams a provider must obtain a provider account number with L&I. This packet includes the application and agreement with instructions, IME Provider Exam sites form (F245-047-000) and Request for Taxpayer ID and Certification - Form W-9 (F248-036-000) (10 pages). If you have questions, please email balk235@lni.wa.gov or call 360-902-6815.

Detalle
Número del formulario F245-046-000
Disponibilidad Online only
Palabras claves doctor, exams, medical, physician, provider application, reapplication
Idiomas English
Fechas válidas 02-2013
Contacto Independent Medical Examiners
Información relacionada
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Independent Medical Examination (IME) Provider Exam Sites


Statewide Payee Registration and W-9 Form


Páginas de Internet For Medical Providers

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