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Jaxplaza Insurance Claim Form ver 02/12, White, 2,500 Sheets
1 Part Laser (2,500 Single Sheets - for Laser/Inkjet Printers). 02/12 Version. Factory Sealed Version 02/12, 2,500 Sheets Accommodates reporting of the National Provider Identifier (NPI) number Jam-free performance Paper are printed in OCR-scannable red ink All forms are government approved to serve federal programs and private insurers as a universal claim form. Approved OMB Manufacturer Jaxplaza, Brand Formsandchecks, Weight 27 Pounds, Dimensions 8 x 12 x 11 inches, model number Is Discontinued No, Material Type Paper, Manufacturer Part Rank Office Products Health Insurance Claim Forms 94, Available

Price is $54.00

Price: $53.99