Enterra Medical- Account Additions

Enterra- Account Additions

Account Name

Your Email

Which option would you like to add to your account?

Portal User

Physician

Facility

Please provide the case number for a past case associated with your PRIA account. This will allow us to easily locate your existing account.

User Contact Name

User Contact Email

User Contact Phone

Physician Name

Physician NPI

Physician Tax ID

Facility Name

Facility Address

City

State/Province

Zip/Postal

Phone Number

Fax Number

Facility Tax ID

Facility NPI

If you are human, leave this field blank.

PROGRAM SUPPORT:

MONDAY–FRIDAY 8:30AM–5:00PM EST
PHONE: 860-374-2693 FAX: 860-261-0639
EMAIL: ENTERRA@PRIAHEALTHCARE.COM