Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Prime Therapeutics LLC before sending sensitive documents. FaxFlow is not affiliated with this organization.
Prime Therapeutics LLC fax number
(877) 254-3794
Authorization Form Processing
Used for: Release of information (PHI) to designated recipient; authorization for release of information
Fax destination details
- Department
- Authorization Form Processing
- Purpose
- Release of information (PHI) to designated recipient; authorization for release of information
- Form
- Authorization for Release of Information — Authorization for Release of Information
- Address
- P.O. Box 64812, St. Paul, MN 55164-0812
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Fill in the member’s name, ID number and date of birth; fill in the name, address and phone number of the recipient; indicate the purpose for the authorization; sign; mail or fax this form to Prime Therapeutics LLC, Attention: Authorization Form Processing, P.O. Box 64812, St. Paul, MN 55164-0812; Fax: 877.254.3794.
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