Enrollment packets on this site:

Are not inclusive of all Idaho Medicaid provider types and specialties;

Applications not listed on this web page may be obtained by contacting your Regional Office;

Include application packets for both group practices and individual practices.

Note: To sign up as a group, individual providers in the group also must be individually enrolled.

Application Steps:

(1) Search the list to the right to find the application for your provider type and specialty.

(2) Print your application and complete it.

(3) Attach or include any specified required documentation.

(4) Sign the application and send or fax to:

EDS Provider Enrollment
P.O. Box 23
Boise, ID  83707
Fax: 208-395-2198 

Note: Electronic submissions will not be accepted.

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