Join Our Network

Thank you for your interest in participating in the Ambetter from NH Healthy Families network! If you would like to receive more information on becoming a provider within our network or would like to receive a contract, please contact us at 1-844-265-1278 or fill out the form below.

Required fields are marked with an asterisk (*)

Contact Information

First Name *

Last Name *

Phone Number *

E-mail Address *

Provider Information

Legal Entity Name *

ATTN *

Provider Address *

City *

State *

ZIP Code *

Provider Identification Numbers

Tax ID *

NPI *

Medicaid Number

Do you provide services in other states besides NH? * Yes No

If yes to the above, please list all states that you do business.

W-9 *

Become An Ambetter Provider in New Hampshire | Ambetter from NH Healthy Families

Join Our Network

Contact Information

Provider Information

Provider Identification Numbers