AHCCCS Provider Address Updates

The Provider Address Update Form is for existing providers to add or change addresses and tax identification numbers on their provider file at AHCCCS.

Click on the appropriate links below:

• AHCCCS Provider Address Update Form [PDF, 281KB]
• AHCCCS Provider Address Update Form - Instructions [PDF, 59KB]
• IRS Form W-9 (required)
  (Please ensure that you enter "W-9" and not "W9" when searching for this form.)

NOTE: Registered AHCCCS Providers may change their correspondence address using the AHCCCS Online provider website.