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

The final step in the application process is to contact Sand Creek for a Letter of Agreement. The Agreement can be sent to you via email, fax, or mail. Once we have received all of your materials and your application has been reviewed, you will receive a confirmation letter in the mail. 

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