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Join the FCC Network

To join the FirstCarolinaCare Insurance Company network, please complete the following form with your contact information to request a contract to participate, as well as complete the NC Uniform Application to Participate as a Health Care Practitioner as shown below.

If you prefer, you may also contact provider credentialing at (910) 715-8100 or toll free at (800) 574-8556 to request that a contract and application be mailed to you.

*Your Name:
*Practice Name:
*Practice Address:
City:  State: Zip:
 *Phone: 
 *E-mail: 
*Tax ID#:
Select One of the Following:
Commercial Product
Medicare Product
Both Commercial & Medicare Product

*required
Comments:
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*Type in the letters shown in the image above.  This is case sensitive.

 

NC Uniform Application to Participate as a Health Care Practitioner Adobe PDF

Submit completed applications to:

Provider Credentialing
FirstCarolinaCare Insurance Company
42 Memorial Drive
Pinehurst, NC 28374

If you have questions regarding the credentialing process, please contact Provider Relations toll-free at (800) 574-8556.

 

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