Entity Type – Type 1: an individual who renders health care services
Is this provider a Sole Proprietor - NO Business Address – must be an address where you can currently receive mail. It is recommended to use your current local mailing address (it can be changed later). Phone Number – must be a phone number where you can currently be reached. Note: This number is public information, and can be looked up by anyone. Once you begin working in your program, it is recommended to change this number to your program phone number. Business Practice Location Address – click the "Same as business Mailing Address" button. Once you begin working in your program, this should be updated to your program's address. Other Identification Numbers – you do not currently have any other identifiers to enter any right now. Endpoints - you do not have any endpoints to enter Taxonomy – Click "Add Taxonomy" 39 – Student Health Care390200000X – Type "student" into the search box, then choose "390200000X – STUDENT IN AN ORGANIZED HEALTH CARE EDUCATION/TRAINING PROGRAM" from the drop down menu. License - Do not add any license information Contact Person – Click the "Same as Provider" button |