Thank you for your interest in Sand Creek’s National Provider Network!

To be considered for membership in Sand Creek's network, please return the following: 

• Provider Application - Make copies of Section 2 for each clinician in your group 
• W-9 Form - only one copy per group needed
• Copies of Professional License(s) & Certification(s)
• Copy of liability insurance
• Resume

 Once we have received all of your materials and your application has been reviewed, the Provider Coordinator will send a Letter of Agreement to be read and signed. The Agreement will be sent to you via email or fax. 

Please don’t hesitate to contact Sand Creek with any questions.