Interested Providers

FMBS with CPC


Please take a moment to answer the questions to assist FMBS in understanding your practice needs, as well as useful information, found in the Frequently Asked Questions, regarding your credentialing status and provider requirements.

Name:
Phone Number:
Best Time to Reach You:
Practice State Location:
Practice Type:

Please Specify:
Are you a:
- or -
Is your birth center facility licensed by your state?
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Monthly Estimate of Clients:
Monthly Estimate of Insurance Clients:
Has your practice ever billed insurance?
- or -
Are you currently contracted with any insurance companies?
- or -
Would you like to become contracted with any insurance policies?
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What services are you interested in Favored Medical Billing providing your practice?
Do you hold malpractice insurance?
- or -
Reason(s) for choosing to obtain a billing provider:
If your practice is outside the state of Arizona,
What are the top insurance companies in your area?:
Please provide specific, need to know regulations regarding your state and your business type:
Please provide any additional information you feel FMBS should know about your practice:
Contact Email: