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NPI Individual: Effective: MalPractice Insurance . Please provide copy of Malpractice Face Sheet Carrier Name: Policy Number: Effective Date: Per Claim Amount: Aggregate Amount: Group / Facility / Practice INFORMATION ... Federal Tax ID: Group NPI: JCAHO Number: Bill on: ( HCFA-1500 ( UB-92 State License (Facility / Hospital Only): Web Site ... ................
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