Provider Network Interest

FOR PROVIDERS

Provider Network Interest

If you would like to receive information about Blue Cross and Blue Shield of Louisiana's provider networks, please complete the form below or call Network Administration at 1.800.716.2299, option 3 or 225.297.2758.

* indicates required field.

Individual Provider Name *

Individual NPI *

Group/Clinic Name

Tax ID *	Group NPI

Correspondence Address *

City *	State *	Zip Code *

Phone Number *	Fax Number

Physical Address *

City *	State *	Zip Code *

Parish *

E-Mail	Confirm E-Mail Address

Specialty *

Network Key Physician/Participating Provider Network Preferred Care PPO HMO Louisiana, Inc. (A wholly owned subsidiary of BCBSLA) Key Dental Network Discount Dental Network FEP Dental Network


Contact Name *	Contact Phone Number *
Comments

Submit

External links open in new windows to websites not controlled by BCBSLA.

DOI

Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association. Copyright © 2010 Blue Cross and Blue Shield of Louisiana. Blue Cross and Blue Shield of Louisiana is licensed to sell products only in the state of Louisiana.

FOR PROVIDERS

Provider Network Interest

Access Other Blue Sites

Our Company

Miscellaneous