Arkansas Municipal League - Great Cities Make A Great State
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Provider Requests

To request that a Provider be contacted to join the MHBF Preferred Provider Network, please fill in the information below. All fields are Required.

Please allow a minimum of 60 to 90 days for the contracting process to be completed before services are rendered. Not all contacted providers may be willing to contract with MHBF.

Your Email:
Provider Name:
Address:
City:
State:
Zip Code:
Phone#:
Type of Provider: (Family Practice/OB-GYN/Cardiologist, etc.)
Requested by:
Phone#:
City:
May I contact you for further information? yes no
   

 

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Arkansas Municipal League | P.O.Box 38 | 301 West 2nd | North Little Rock, AR 72115
Phone: (501) 374-3484 | Fax: (501) 374-0541

©2006 Arkansas Municipal League. All Rights Reserved.

 

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