Application for a Medicare provider number for an allied health professional form (HW020)
Use this form to request a provider number for an additional location or to re-open a closed location if you are an Allied Health Professional.
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.
Page last updated: 13 March 2019