Contact Us  |
 FAQs  |
Registration Step 1 of 2 - Personal Information
Click for help
* Indicates a required field.
Please provide the following information to get started!

If you are an individual registering as a rendering provider, please enter your Social Security Number as Federal Tax ID. If you are a business entity registering as a rendering provider, please enter your Federal Tax ID.


*Enter 9-digit Federal Employee Identification Number.  If you are an individual enrolling as a rendering provider, enter your Social Security number.

*

© 2024 Indiana Medicaid | R4.2 | Privacy Policy | Medicaid Provider Home Page