Join Our Network

Thank you for your interest in joining the PHCS or MultiPlan Network. The following information is needed in order to process your application request. All fields must be completed.

Enter your nine digit tax identification number (TIN):

	YES	NO
1. Do you currently have admitting privileges at a PHCS Network hospital?
2. Are you an individual practitioner?
3. Are you the only provider billing with your practice TIN?
4. Do you practice through an IPA, PHO or other group practice?
5. Do you practice in only one state?
Please indicate your primary specialty: