Step 2 of 7

Tell us about your company

Basic details so we can verify your license and wire up payer routing. We'll pre-fill as much as we can — fields with * are required.

Completion

1/ 7 sections

Operating state

—

Not set

Identity

Who you are on paper

Business name*

Tax ID / EIN*0/9 digits

Business email*

Phone*

Medicaid Provider IDOptional

Websiteoptional

Business License Numberoptional

Business address

Where your dispatch lives

Search address*

Mailing address is the same as physical

Mailing address*

Where we’ll send legal notices, checks, and tax forms.

Technology

How you dispatch trips

Do you use an ATMS (automated trip management system)?

Provider profile

—

Your business name

your state · NEMT

—

Phone

—

Address

—

Tax ID / EIN

Missing

Medicaid Provider ID

Optional

ATMS

—

Completion14%

Still needed: Business name · Email · Phone · 9-digit EIN · Business address · Mailing address · ATMS answer