Provider Information Update Form

In order to keep our directory of information accurate and current, please update us with any changes associated with your contracted Tax ID Number by completing our Provider Information Update Form.  If you prefer, you may fax, mail, or email ( a copy of your changes on professional letterhead. Our fax number is 215-343-8983.  Please include the information that MHC currently has on file in addition to your new information.  If you have any questions, please feel free to contact us. Thank you.

1501 Lower State Road
Building D, Suite 200
North Wales, PA 19454