This version of the form is not currently in use and is provided for reference only. Download this version of Form 3109 for the current year.
This is a legal form that was released by the Texas Health and Human Services - a government authority operating within Texas. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is Form 3109 Provider Information Change?
A: Form 3109 Provider Information Change is a document used in Texas to update and make changes to provider information.
Q: Who can use Form 3109 Provider Information Change?
A: Form 3109 Provider Information Change can be used by healthcare providers in Texas.
Q: What information can be changed with Form 3109 Provider Information Change?
A: Form 3109 Provider Information Change can be used to change various provider information such as contact information, practice address, billing information, etc.
Q: How do I fill out Form 3109 Provider Information Change?
A: To fill out Form 3109 Provider Information Change, you need to provide your current information and the updated information you want to change.
Q: Are there any fees associated with Form 3109 Provider Information Change?
A: No, there are no fees associated with submitting Form 3109 Provider Information Change.
Q: How long does it take for the changes to be processed?
A: The processing time for changes made through Form 3109 Provider Information Change may vary. It is recommended to check with the Texas Health and Human Services Commission for specific details.
Form Details:
Download a fillable version of Form 3109 by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.