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BlueCross BlueShield of Texas
   
         
     
 

NPI Online Submission Form

   

Share your NPI with BCBSTX today!

We've made it even easier for you to share your NPI with BCBSTX! Simply fill in all of the fields below and click on “Submit” to forward your information to us.

We will attempt to verify your NPI using the NPPES registry. If your NPI is not found on the NPI Registry, or if any data doesn't match, then we reserve the right to request submission of your confirmation notice (letter or e-mail) from the Enumerator.

All fields are required. (If not applicable, write "N/A")

Legal Name of Provider:
Suffix/Title/Credential:
 
Type 1 Individual NPI:
Legal Business Name of Group:
Type 2 Organizational NPI:
IRS Tax ID Number (SSN, ITIN, or EIN):
Primary Office Address:
City/State/Zip:
Contact's Name:
Contact's telephone number:
Contact's e-mail address:
   

Attestation:
I hereby certify that the NPI information submitted within this form is accurate and complete in accordance with the confirmation letter or email sent to me by the NPPES Enumerator. I understand and agree that any misrepresentation in this form by omission or affirmative statement may result in reimbursement delays and/or other disruptions in service.

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A Division of Health Care Service Corporation,
a Mutual Legal Reserve Company, an Independent Licensee of the
Blue Cross and Blue Shield Association.
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