Join Our Network

Thank you for your interest in participating with Ambetter from Superior HealthPlan! If you would like to receive more information on becoming a provider within our network, please complete the form below.

If you are already contracted with Superior, please visit the Add a Product page and complete the online form to add Ambetter to your contract.

Required fields are marked with an asterisk (*)

Enter Provider Name *

Specialty *

Sub-Specialty

Enter Provider NPI Number *

Enter Provider Tax ID Number *

Mailing Address Line 1 *

Mailing Address Line 2

City *

State *

Zip Code *

Texas County *

Primary Hospital Affiliation *

Hospital Affiliation 2 (Optional)

Hospital Affiliation 3 (Optional)

Do You Have Additional Hospital Affiliations?

Yes No

Contact Name *

Phone Number *

Contact Email *

Practice Location Zip Code 1 *

Practice Location Zip Code 2

Practice Location Zip Code 3

Agreement*

I understand that this inquiry does not guarantee my participation in the Ambetter network.

Agreement*

I understand that failure to complete this inquiry accurately and completely will result in the delay of evaluating my request.