Request a Provider for Nomination to the Mississippi Physicians Care Network.

Please complete the following form to request a provider be added to our network:

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Please fill out this information about the PROVIDER.

Provider Name     

Provider Specialty  Please select ADDICTION MEDICINE ADOLESCENT MEDICINE ALCOHOL & MENTAL CENTER ALCOHOL AND DRUG CENTER ALLERGY & IMMUNOLOGY AMBULATORY SURGICAL CTR ANESTHESIOLOGY AUDIOLOGY BARIATRIC MEDICINE BEHAVIORAL HEALTH/CHEMICAL DEPENDENCY/RESIDENTIAL TREATMENT CTR BIOTECH PHARMACEUTICAL SERVICES BONE GROWTH SIMULATOR BRACES, ORTHOPEDIC Breast Prosthesis & Prosthetics CARDIAC EVENT MONITORING CARDIOLOGY CARDIOVASCULAR CARDIOVASCULAR DISEASE CERTIFIED NURSE MIDWIFE CHILD & ADOLESCENT PSYCHIATRY Child Psychology CHIROPRACTIC CRITICAL CARE MEDICINE CRNA DENTIST DERMATOLOGY DERMATOPATHOLOGY DIABETIC PUMP & SUPPLIES - DME DIAGNOSTIC MAMMOGRAPHY & ULTRASOUND FACILITY DIAGNOSTIC RADIOLOGY FACILITY DIAGNOSTIC TESTING FACILITY DIALYSIS SERVICE FACILITY DURABLE MED EQUIP ELECTROPHYSIOLOGY EMERGENCY MEDICINE ENDOCRINOLOGY ENDOSCOPY CENTER EXTENDED CARE FACILITY FAMILY PRACTICE GASTROENTEROLOGY GENERAL PRACTICE GENETICS GERIATRIC MEDICINE GERIATRIC PSYCH FACILITY GERIATRIC PSYCHIATRY GYNECOLOGIC ONCOLOGY GYNECOLOGY HAND SURGERY HEMATOLOGY HEMATOLOGY / ONCOLOGY HOME HEALTHCARE HOME INFUSION HOME MEDICAL EQUIPMENT HOME SLEEP TESTING HOSPICE AND PALLIATIVE MEDICINE HOSPICE CARE FACILITY HOSPITAL HYPERBARIC MEDICINE HYPERTENSION IMMUNOLOGY INFECTIOUS DISEASES INFERTILITY INFUSION INPATIENT FACILITIES INTERNAL MEDICINE INTERVENTIONAL CARDIOLOGY LABORATORY SERVICES LICENSED MARRIAGE and FAMILY THERAPY LICENSED PROFESSIONAL COUNSELOR LONG TERM CARE FACILITY MAGNETIC RESONANCE IMAGING (MRI) MATERNAL FETAL MEDICINE MATERNITY MANAGEMENT SERVICES MINOR MEDICAL CENTERS MULTISPECIALTY CLINIC NEONATOLOGY NEPHROLOGY NEUROLOGY NEUROPHYSIOLOGY NEURORADIOLOGY NEUROSURGERY NUCLEAR MEDICINE NURSE PRACTITIONER NURSING HOME NURSING SERVICE OB/GYN OB/GYN (High Risk Only) OCCUPATIONAL MEDICINE OCCUPATIONAL THERAPY ONCOLOGY ONCOLOGY SERVICES OPHTHALMOLOGY OPTOMETRY ORTHOPEDIC SURGERY ORTHOTIC SUPPLIES OSTOMY SUPPLIES OTOLARYNGOLOGY OTOLOGY PAIN MANAGEMENT PATHOLOGY PATHOLOGY LAB PEDIATRIC & ADOLESCENT MEDICINE PEDIATRIC ALLERGY AND IMMUNOLOGY PEDIATRIC CARDIOLOGY PEDIATRIC CRITICAL CARE PEDIATRIC DENTISTRY PEDIATRIC EMERGENCY MEDICINE PEDIATRIC ENDOCRINOLOGY PEDIATRIC GASTROENTEROLOGY PEDIATRIC HEMATOLOGY PEDIATRIC NEPHROLOGY PEDIATRIC NEUROLOGY PEDIATRIC ONCOLOGY PEDIATRIC ORTHOPEDIC SURGERY PEDIATRIC PULMONARY MEDICINE PEDIATRIC RADIOLOGY PEDIATRIC RHEUMATOLOGY PEDIATRIC SURGERY PEDIATRIC UROLOGY PERINATOLOGY PHARMACY PHYSIATRICS PHYSICAL MEDICINE PHYSICAL THERAPY PHYSICAL THERAPY / REHABILITATION SERVICES PHYSICAL THERAPY ASSISTANT PHYSICIAN ASSISTANT PHYSIOTHERAPY PLASTIC SURGERY PODIATRY PREVENTATIVE MEDICINE Preventive Medicine PRIVATE PSYCHIATRIC HOSP. PROSTHETICS & ORTHOTICS PSYCH AND SUBSTANCE ABUSE TREATMENT PSYCH AND SUBSTANCE ABUSE TREATMENT FACILITY PSYCHIATRY PSYCHOLOGICAL COUNSELING FACILITY PSYCHOLOGY PULMONARY MEDICINE RADIATION MEDICINE RADIATION ONCOLOGY RADIOLOGICAL SERVICE FACILITY RADIOLOGY REFERENCE LAB REHABILITATIVE MEDICINE FACILITY REPRODUCTIVE ENDOCRINOLOGY RESIDENTAL TREATMENT CENTER RESPIRATORY THERAPY RHEUMATOLOGY SCREENING MAMMOGRAPHY Senior Care Unit SKILLED NURSING FACILITY SLEEP DISORDERS FACILITY SLEEP LAB SLEEP MEDICINE SOCIAL WORKER SPECIALTY PHARMACY Speech Therapy SPEECH THERAPY FACILITY SPEECH/LANGUAGE PATHOLOGY SPORTS MEDICINE SURGERY / CARDIOVASCULAR & THORACIC SURGERY / COLON & RECTAL SURGERY / GENERAL SURGERY / OPHTHALMIC PLASTIC & RECONSTRUCTIVE SURGERY / ORAL & MAXILLOFACIAL SURGERY / PERIPHERAL VASCULAR Surgery / Vascular SURGERY/TRANSPLANT SURGICAL ONCOLOGY SWING BED FACILTY THORACIC SURGERY TOXICOLOGY TRAUMA SURGERY URGENT CARE URGENT CARE FACILITY UROGYNECOLOGY UROLOGY WOUND CARE WOUND CARE FACILITY    

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Provider State   Please select AK AL AR 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     

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