• Request for Privileges

    To help us better serve you, tell us a bit about who you are...
  • Request for Privileges

    Please fill out the following information regarding the requested provider...
  • Office Contact

    Providing an office contact (name, email, and phone) allows for the credentialing process to be completed much more time efficiently. Please take the time to locate this information.
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    Pick a Date
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    Pick a Date
  • Once you have made your selection(s) click Submit.

    Please note: Once this form has been submitted, the provider will be added to the facility and sent a connection rquest within 48 hours. Please contact credentialing@usrenalcare.com with any questions. 

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