Medical e-Bill, Incorporated - "Accuracy, Integrity and Personal Service"
Verification
 
Please Complete the form below and provide all required information. If you have any questions regarding this form please feel free to contact us at 832.847.4081.
 
Insured or Subscriber Information

Name*
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Group Number*
Home Address*
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Home Phone*
Email
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Doctor or Therapist Name*
Patient Information

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Patient D.O.B.*
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Medical e-bill, Incorporated
 Phone: 832.847.4081 Toll Free Phone: 1.888.397.1150 Fax: 281.569.4624
 E-mail: medicalebill@msn.com