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.
Click here to find your Account Management Representative.
To ensure your request is processed timely, please submit using the most recent version of Internet Explorer, Chrome, Safari or FireFox.