| 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 | 
 |