| Parent File | Name | Number | Package |
|---|---|---|---|
| BDP DESG SPECIALTY PROVIDER(#90360.1) | PROVIDER NAME | 90360.11 | IHS Designated Provider |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | PROVIDER NAME | 0;1 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
| .02 | USER LAST UPDATED | 0;2 | POINTER TO NEW PERSON FILE (#200) | ************************REQUIRED FIELD************************ NEW PERSON(#200)
|
| .03 | DATE LAST UPDATED | 0;3 | DATE | ************************REQUIRED FIELD************************
|
| .04 | EFFECTIVE/START DATE | 0;4 | DATE |
|
| .05 | INACTIVE/STOP DATE | 0;5 | DATE |
|