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Form #
CMS 855S
Form Title
Medicare Enrollment Application - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers
Revision Date
2013-01-01
O.M.B. #
0938-0685
O.M.B. Expiration Date
2016-05-31
CMS Manual
N/A
Special Instructions
N/A