Requestor Information: (Items outlined in red are required)

Provider Information: (Items outlined in red are required)

And/or

Provider's Office Contact Information:

If you would like to add a provider's / group's additional locations, please indicate below. Enter additional locations in the Comments section.

Additional Locations:


Applicable laws and regulations require updates to the information displayed on the provider network list on at least a quarterly basis. MEDEX updates its provider network listing information more frequently than laws and regulations require. All providers listed were participating providers accepting Workers' Compensation patients at the time of the most recent update.

It is possible that since the time of the last update to the provider network listing, provider or facility information may have changed. We recommend confirming all information with selected providers.

Participating providers and facilities are independently contracted businesses or entities, and are solely responsible for any insurances and liabilities, professional or otherwise, arising from their acts or omissions.

Available MEDEX Network Resources:

Email (Preferred): MPNEnrollment@medexhco.com

Phone: 1-877-775-7772

Provider Feedback Button (Preferred): Embedded within each provider or group profile within listed search results

Email: Providerrelations@medexhco.com

Phone: 1-877-775-7772

Email (Preferred): MAA@medexhco.com

Phone: 1-888-509-1474

Fax: 1-888-651-0088

Email (Preferred): Providernomination@medexhco.com

Fax: 1-888-465-4088

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Date of last data update: October 22, 2021