Provider Type Summaries
Please select the provider type from the list below for application information.
If you have any questions on the information provided for the provider types below, contact Provider Enrollment from 8 a.m. - 4:30 p.m. ET Monday through Friday at (877) 838-5085.
The free Adobe Acrobat Reader is required to view and print these documents.
(Mar. 17, 2016) - Provider type 76 - Multi-Therapy Agency, is anticipated to be effective in June, 2016. Providers may begin submitting applications to enroll in Medicaid as this provider type on May 15, 2016 but applications will be held and will not be processed until state regulations are final. The information provided for this provider type is subject to change pending adoption of state regulations.
For more information about the new therapy process, please read the
If you have questions about the therapy process, contact the Department of Medicaid Services at 502-564-7540. If you have any questions regarding enrollment after May 15, 2016, please contact Provider Enrollment at 1-877-838-5085.
||Current Provider Number and Type