Join Our Network

Thank you for your interest in becoming a network provider with Ambetter of North Carolina Inc.! Please complete the below information and one of our team members will contact you within the next 5 business days. We look forward to working with you to improve the health of the community. If you have any questions please contact us at 1-833-863-1310.

Required fields are marked with an asterisk (*)

Are you currently contracted with an Independent Practice Association (IPA) or a Physician Hospital Organization (PHO)? * Yes No

Enter IPA or PHO Name *

Select Your Primary Specialty *

Sub-Specialty

Enter Provider Name *

Enter Group Practice Name *

Enter Provider Tax ID Number (e.g. 999999999) *

Enter Provider NPI Number *

Enter Group NPI Number

Primary Practice Address *

City *

State *

Zip Code *

County

Contact Name *

Contact Number *

Contact Email *

Agreement * I understand this inquiry does not guarantee my participation in the Ambetter of North Carolina Inc. network.

Agreement * I understand that failure to complete this inquiry accurately and completely will result in the delay of evaluating my request.

Join The North Carolina Provider Network | Ambetter of North Carolina

Join Our Network