Provider Subscription Form
Subscribe to Capital Blue Cross Provider Communications
Let us know a little about you and your provider practice and/or facility. We’ll do our best to make sure that only the information that applies to you makes it to your inbox.
Provider Subscription Form
Required fields are noted with an asterisk
*
Tell us about yourself
*
First name
*
Last name
*
Email
Tell us about your practice/facility
*
Practice/facility name
*
What category best describes your practice/facility?
Select a category
Family practice or Pediatrics
Hospital/Facility
Specialty
Surgery
Therapy
Other
Health system affiliation (optional)
National Provider Identifier (optional)
Where do you receive mail for your practice/facility?
Practice/facility mailing street address
Practice/facility mailing city
Practice/facility mailing state
Practice/facility mailing zip code
County
