.02 |
Direct Global Read & w/Fileman |
The name of your facility from the Institution file.
|
FACILITY NAME |
0;2 |
1.05 |
Direct Global Read & w/Fileman |
The facility federal tax ID number.
|
FEDERAL TAX NUMBER |
1;5 |
19;.02 |
Direct Global Read & w/Fileman |
The Pay- To Provider name.
|
PAY-TO PROVIDER NAME |
19;0-0;2 |
19;1.01 |
Direct Global Read & w/Fileman |
Pay-to Provider Street Address 1
|
Street Address 1. |
19;0-1;1 |
19;1.02 |
Direct Global Read & w/Fileman |
Pay-To Provider Street Address 2
|
Street Address 2 |
19;0-1;2 |
19;1.03 |
Direct Global Read & w/Fileman |
Pay-To Provider City.
|
City |
19;0-1;3 |
19;1.04 |
Direct Global Read & w/Fileman |
Pay-To Provider State.
|
State |
19;0-1;4 |
11.03 |
Direct Global Read & w/Fileman |
The default Pay-To Provider
|
Default Pay-To Provider |
11;3 |
19;1.05 |
Direct Global Read & w/Fileman |
The Pay-To Provider zip code.
|
Pay-To Provider Zip Code |
19;0-1;5 |