Existing providers can update the following information using a Provider Information Change form:

• Mailing address
• Physical address (as long as the new physical address did not result in a new Medicare number)
• Tax ID number 

Changing Principal Information for Existing Providers

Each principal for an existing provider must provide up-to-date information. If the information changes for a principal or a new principal is added, the principal needs to file a revised Principal Information Form (PIF-2), which is part of the Texas Medicaid Enrollment Application.

All completed forms should be sent to the following address:

 

Texas Medicaid & Healthcare Partnership
ATTN: Provider Enrollment
PO Box 200795
Austin , TX 78720-0795

If you have any questions about the enrollment process, you can call TMHP Provider Enrollment at 1-800-925-9126, Option 2.