National Network Sign-up Form
 

If you would like to nominate an imaging provider for participation in the MedSolutions Imaging Network, please submit the following information. Submission of the form does not guarantee membership but will expedite the recruitment and credentialing process.

Join MedSolutions' National Network
Your Name
Company Name
Address 1
Address 2
City
State
Zip
List Additional Sites
List Additional Sites
List Additional Sites
List Services Available
(CT, MRI, PET, Nuc Card, Ultrasound, X-Ray, Fluoroscopy)
Phone Number
Fax Number  
Email Address
Parent Company
Comments  

Thank you.

 

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