Join Our Network

Thank you for your interest in participating in the Ambetter of Oklahoma network! If you would like to receive more information on becoming a provider within our network, please complete the form below.

Required fields are marked with an asterisk (*)

Enter Provider Name *

Specialty *

Sub-Specialty

Enter Provider NPI Number *

Enter Provider Tax ID Number *

Mailing Address Line 1 *

Mailing Address Line 2

City *

State *

Zip Code *

Oklahoma County *

Primary Hospital Affiliation *

Hospital Affiliation 2 (optional)

Hospital Affiliation 3 (optional)

Do You Have Additional Hospital Affiliations? Yes No

Contact Name *

Phone Number *

Contact Email *

Practice Location Zip Code 1 *

Practice Location Zip Code 2

Practice Location Zip Code 3

Agreement * I understand that this inquiry does not guarantee my participation in the Ambetter network.

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

Become An Ambetter Provider in Oklahoma | Ambetter of Oklahoma

Join Our Network