Update your Washington Medicaid Provider Information
To update your address or phone number please FAX us (360-725-2144) a letter with your 7-digit provider number and your NPI number with your old information and new information; or call:
| Provider Enrollment PO Box 45562 Olympia, WA 98504-5562 |
1-800-562-3022 option 2, then option 5 |
To Update your Professional license you may FAX a copy of your license to 360-725-2144. Make sure you include your 7-digit Medicaid provider number on the professional license.
NEW !!! Complete the Core Provider Agreement and Provider Application (DO NOT USE OLD APPLICATION!)- Washington state law requires that you use the official Medicaid Core Provider Agreement and Provider Enrollment Application forms.
- We do not accept Washington Practitioner Applications.
For information on National Provider Identifier (NPI)
If you have questions about your enrollment application, contact us via email or call 1-800-562-3022, option 2, then option 5 7:30 am to 4:30 pm Monday - Friday.
Page modified: November 2009
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