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Documentation for DMEPOS providers
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1
Your contact information
Your name
The email address for sending your user name and password
Your phone number
2
Your practice or business information
The practice or business information that you would like to appear on your documentation
Street address
City, State and ZIP code
Choose One
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
CNMI
3
Please share a little information about yourself
Please indicate one or more types of DMEPOS products that you deal with
DME/HME
Wheelchairs
Oxygen
Supplies
Orthotics
Prosthetics
Diabetic Footwear
Mastectomy
4
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