Provider Comp Network, Inc.
400 Niles Cortland Rd SE - Ste. D
Warren, Ohio 44484
Phone: (330) 856-7264
Fax: (330) 609-6000
Email Us

To become part of the Provider Comp Network and/or to provide Independent Medical Exams for employers, please submit the following information to request a contract:

	Provider Name
	Group Name
	Address
	City
	State
	Zip
	Phone
	Fax
	Federal ID#
	BWC Provider ID#
	Email
	Comments/Questions

Provider Comp Network, Inc. © 2004
400 Niles Corland Rd SE - Ste. D
Warren, Ohio 44484
Ph. (330) 856-7264 Fax (330) 609-6000
WWW.PCNPPO.COM