Provider Account Application - Independent Medical Examiner (IME)
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| Título |
Provider Account Application - Independent Medical Examiner (IME) (Un formulario electrónico)- 841 KB PDF) |
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| Descripción | In order to do independent medical exams a provider must obtain a provider account number with L&I. This packet includes the application and agreement with instructions, IME Provider Exam sites form (F245-047-000) and Request for Taxpayer ID and Certification - Form W-9 (F248-036-000) (10 pages). If you have questions, please email balk235@lni.wa.gov or call 360-902-6815. |
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| Detalle | ||
| Número del formulario | F245-046-000 | |
| Disponibilidad | Online only | |
| Palabras claves | doctor, exams, medical, most requested forms, physician, provider application, reapplication | |
| Idiomas | English | |
| Fechas válidas | 02-2013 | |
| Contacto |
Independent Medical Examiners
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| Información relacionada | ||
| Documentos | Independent Medical Examination (IME) Provider Exam Sites Statewide Payee Registration and W-9 Form |
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| Páginas de Internet | For Medical Providers | |
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