Sand Creek

Application Materials

Thank you for your interest in Sand Creek’s National Provider Network!

To be considered for membership in Sand Creek’s network, please return the following:
  • Provider Application
  • W-9 Form – only one copy per group needed
  • Copies of Professional License(s) & Certification(s)
  • Copy of liability insurance
  • Resume

All application forms are a fillable and savable pdf form. Once we have received all of your materials and your application has been reviewed, the Provider Coordinator will send a Letter of Agreement to be read and signed. The Agreement will be sent to you via email or fax.

Please don’t hesitate to call us with any questions at 888.243.5744.


Corporate Fax: 651.430.9753 or Email: