Individual Applications - This application is to be completed by doctors, dentists, therapists, counselors and nurses.
Group Applications - This application is to be completed by providers who have two or more individual providers working under a Tax ID Number.
Supplier Applications - This application is to be completed by the following type of providers: ambulances, labs, portable x-ray suppliers, pharmacies and durable medical equipment suppliers.
Institutional Applications - This application is to be completed by the following type of providers: hospitals, ambulatory surgical centers, skilled nursing facilities, birthing centers, hospice and home health agencies.
Corporate Service Provider Application - This application is to be completed by the following type of providers: Radiation therapy, cardiac cauterization clinics, freestanding sleep disorder diagnostic centers, independent physiological labs, freestanding kidney dialysis center, freestanding MRI centers, comprehensive outpatient rehabilitation facilities, freestanding bone marrow transplant centers, diabetic self management education programs (ADA Accredited).
All provider applications should be returned to the following address:
Tricare South Region
Provider Data Management
P.O. Box 7039
Camden, SC 29020-7039