Join Our Participating Provider Network

Are you looking to reach more patients and grow your business? Join our provider network and take advantage of all the perks HealthLink offers participating providers.

Please note this nomination does not guarantee the practitioner will become a participating HealthLink provider or facility. The contracting and credentialing process can take 90-120 days.

As part of the contracting process each physician, hospital and other healthcare provider must satisfy the applicable selection standards before he or she is eligible to apply for participation in one or more of HealthLink's programs or networks. Please review HealthLink Standards of Participation prior to completing the below form.

Type of Request
Requestor Information
Provider Information
Last Name and Suffix, First Name, Middle Initial, and Provider Degree - MD, DO, PhD, etc.)
Hospital Privileges
Malpractice Coverage
$
$
Primary Office Address
Secondary Office Address
Billing Address