Welcome Logout

National Provider Identifier (NPI) Form

Health Net Federal Services, LLC offers payments and remittances by National Provider Identifier (NPI) number. The NPI billed on the claim will determine where payment and remittance will be sent. Complete the NPI form below for medical facilities, groups, clinics, and sole practitioners and durable medical equipment suppliers. 

Return completed form(s) to:

TRICARE West Provider Data Management
PO Box 202106
Florence, SC 29502-2106
Fax: 1-844-730-1373

  • Created: Aug 16, 2018
  • Modified: Jan 8, 2018
  • View »