RETIRED SurveyMonkey email collection, don't use but keeping for records

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* 1. What is your Provider/Group name?

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* 2. What is your 10-digit billing NPI number? (Atypical providers may enter 'N/A')

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* 3. What is your 9-digit Tax ID number?

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* 4. What is your email address?

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* 5. Would you like to add additional email addresses for people in your office who would like to receive the Blue Review?

Yes

*Questions marked with an asterisk are required.

Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and blue Shield Association