Mercer FirstChoice is expanding its network to meet the demands of our growing patient base. We are interested in adding qualified health care professionals and facilities. If you are interested in joining the network please complete the Mercer FirstChoice Provider Enrollment Form.
Mercer FirstChoice Provider Enrollment Form
- Complete the Enrollment Form in full (group practices and partnerships should complete an enrollment form for each provider of services).
- Completed form and copies of the requested items can be faxed to 724-983-3824 or sent via mail to Mercer FirstChoice, c/o Chris Golub, 740 East State St., Sharon, PA 16146. Once this is received, an agreement will be mailed for your signature.
- Participation will not be in effect until a signed agreement has been
received along with the requested items.
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Mercer FirstChoice Enrollment Form