Medpoint Management



    Provider Portal User Request Form
  Request User Account
     
  Vendor TaxID:
* If this account requires access to multiple TaxIDs please list them all in the "Note" field below. Provide TaxID, NPI, and Name for each entity.
  Vendor Name:
  First Name:
  Last Name:
  Email:
  Phone:
     
  Login Name: Min Length: 8 (6) chars (2) numbers
* You will be assigned a temporary password once we've reviewed your request
  
  Note:
     
  Requested Provider Access:
You must request access to at least 1 Provider. Please use the search below to find providers...
Provider Search Panel
  Group:
  Provider NPI or Name: