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PROVIDER WEB PORTAL

WEB PORTAL PROVIDER APPLICATION FORM – Please Click here

You will need a User Name and Password to log into our provider web portal.For access to our provider web portal, please fill out the Web Portal Provider Application by clicking the link above.

Please email or fax the signed and dated application to:

providerrelation@crystalcoastmso.com
FAX: (949)535-1841 (Attention: Provider Relation)

https://medlogixmso.quickcap.net/php/ipa/index.php#med_dashboard_frame&link_module=18&link_id=966442