For Providers Join Our Network Thank you for your interest in becoming part of the HealthTeam Advantage Provider network. Please complete the form below. * Indicates required fieldsGroup InformationGroup Name* Specialty* Group NPI#* Tax ID#* AddressStreet Address* Address Line 2* City* State / Province / Region*AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZIP / Postal Code* County* PractitionersAdd Practitioners Add individual practitioners at this location Untitled Physician Name Physician Degree Individual NPI# Specialty Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Contact InformationName First Last PhoneEmail* Enter Email Confirm Email Additional Information About Your Group:CAPTCHA