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December 2016 Texas Medicaid Provider Procedures Manual

Section 1: Provider Enrollment and Responsibilities : 1.1 Provider Enrollment and Reenrollment : 1.1.9 Required Enrollment Forms : 1.1.9.3 Provider Information Form (PIF-1)

1.1.9.3
The PIF-1 must be completed by, or on behalf of, the provider that is applying for enrollment. If the provider is an entity, the PIF-1 must be completed on behalf of the entity.

Texas Medicaid & Healthcare Partnership
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