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» Provider Information » Provider FAQs » Join the IHG Network » Update Provider Record » Search for Provider » Provider Reference Card (PDF) » CA Payment Guidelines Update My Provider Record To update your provider information, please fill out the form below. We will verify the information you enter and update your Provider Record. Fields with an asterisk (*) are required. First Name * A value is required.A value is required. Last Name * A value is required.A value is required. Email A value is required.Invalid format. Specialty Tax ID Number * A value is required. For New Tax ID Provide Previous Tax ID Number Address * A value is required. A value is required. City * A value is required.A value is required. State * - Select A State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code A value is required.Invalid format. Address Type * [ please select ] Practice Billing Mailing Phone A value is required. Fax A value is required. Additional Information