Geisinger Health Plan

NPI Type 2 Online Submission Form

Please use this form to register your Type 2 (Organizational) National Provider Identifier (NPI) number with the Health Plan. NPI Type 2 entities are organization health care providers/groups.

Each NPI must be reported on a seperate form.


* indicates a required field.

* Entity Name :

* Main Address :                    Address 1


Address 2


City

State Zip

Health Plan Assigned Provider Number :
* Tax ID :
* Type 2 NPI 10-digit number :
Taxonomy(ies) registered with NPPES of Specialty: