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We're happy to add your email address to our database for electronic communications, such as the monthly Blue Review newsletter. Email addresses are stored in a secure location and will not be shared.

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* 1. What is the provider or group name?

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* 2. What is the facility or clinic name?

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* 3. What is your 10-digit billing NPI number? (Atypical providers may enter 'N/A')

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* 4. What is your 9-digit Tax ID number?

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* 5. What is your email address?

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* 6. Would you like to add additional email addresses for people in your office who would like to receive the Blue Review?

*Questions marked with an asterisk are required.

Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and blue Shield Association

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