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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.
Form 3109 Provider Information Change - Texas
What Is Form 3109?
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.
FAQ
Q: What is Form 3109 Provider Information Change?
A: Form 3109 Provider Information Change is a document used in Texas to update the information of a healthcare provider.
Q: Who needs to fill out Form 3109 Provider Information Change?
A: Healthcare providers in Texas who need to update their information are required to fill out Form 3109.
Q: What information can be changed using Form 3109 Provider Information Change?
A: Form 3109 can be used to update various information including the provider's name, address, phone number, and other contact details.
Q: Is there a fee for filing Form 3109 Provider Information Change?
A: No, there is no fee associated with filing Form 3109 Provider Information Change.
Form Details:
- Released on April 1, 2023;
- The latest edition provided by the Texas Health and Human Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
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.
