Add a Practice Location to an Existing Contract
Contracted providers can use this form to add a location to an existing contract. Please note, if you are affiliated with a third party Delegate Manager, all changes must be made at the request of the Delegate. Contact your Delegate Manager for additional information.
NOTE: Medical Providers and Groups (MD, DO, DC, DPM and Physician Extenders) who want to add a new practice location and are currently credentialed by Superior; or ancillary providers who want to add a new practice location that will operate under the same state license and TIN/NPI combination should contact your Account Management Representative.
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