Apply to become a TRICARE Network Provider for Humana Military

If you have previously submitted this form, you do not need to re-submit at this time. Thank you for your diligence; however only one entry is necessary per tax ID number (TIN/EIN).
If you are interested in participating in Humana Military’s new East region network as a contracted provider of services for the next generation of TRICARE contracts, please fill in and submit the requested information. You will be contacted by a representative shortly.
Specialty
Business/Group Name
TIN/EIN
Group NPI
Address 1
Address 2
City
County
State
Zip Code
Fax
( ) -
Are you a current TRICARE Network Provider?

Contact Information

Name
Email
Phone
( ) - Extension