PH: (800) 801-9772 | (316) 683-4111
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Physician Group Declaration of Agreement

To contract with ProviDRs Care, please complete the Group DOA below and attach the required W-9. Upon submission, please allow 30 days for full execution of the agreement. If additional information is required, you will be contacted by our Provider Relations Department.

You may also print the Group DOA found here Physician Group DOA and submit it along with a copy of the W-9 by email, fax or mail:
Fax: (316) 683-6255
Mail: 238 N Waco St
Wichita, KS 67202

Please contact Provider Relations if you have questions regarding your agreement or the contracting process at 1 (800) 801-9772, option 4, option 3, or email us at