For Providers – License number, NPI number and DEA number and title (M.D. or O.D., etc.)
1. Documents that establish both identity such as:
- Permanent Resident Card
- Driver’s license or ID
2. CPR Card
3. Immunization Record with the following completed:
- MMR (if born after1957)
- Hepatitis B
4. TB Skin Test. If positive, Chest X-Ray Report is needed.
5. Complete Employee Application
6. Copy of license(s) and/or certification(s)
1. New Hire Information Sheet
2. Completed I-9 and documents to establish ability to work in U.S.A.
3. W-4 Tax Form – DE-4