Common Contracts
3 similar Provider Participation Agreement contracts
PROVIDER PARTICIPATION AGREEMENT Please review, sign page 5 and return to Laura Locicero at fax (516) 465-8002, or send a signed, scanned document to ciipa@nshs.edu.Provider Participation Agreement • September 17th, 2020 • New York
THIS AGREEMENT, made by and between North Shore-LIJ Network, Inc. and its related IPA, North Shore-LIJ Clinical Integration Network IPA, LLC (the entities collectively shall be referred to as the “CIIPA”), and ___________________________________ (“Provider”) a Provider licensed to practice ________________________________ in the State of New York with an address at _________________________________, _______________________ is effective as of the date of its execution by CIIPA (“Effective Date”). This Agreement sets forth the terms under which Provider agrees to participate in CIIPA.
PROVIDER PARTICIPATION AGREEMENTProvider Participation Agreement • November 7th, 2008 • New York
PROVIDER PARTICIPATION AGREEMENTProvider Participation Agreement • November 4th, 2008 • New York
THIS AGREEMENT, made by and between North Shore-LIJ Network, Inc. and its related IPA, North Shore-LIJ Clinical Integration Network IPA, LLC (the entities collectively shall be referred to as the “CIIPA”), and (“Provider”) a Provider licensed to practice in the State of New York with an address at ,
