Independent Review Organization certification | Washington State Office of the Insurance Commissioner

Independent Review Organization Certification Request

Required fields are marked with an asterisk (*)

What is the exact legal name of the independent review organization (IRO)? *

What is the Federal Employer Identification Number (FEIN) of the independent review organization? *

Is the IRO doing business as a name different than the legal name? * Yes No

Contact Name *

Email Address *

Please confirm your email address *

Country *

Phone Number *

Extension

Street Address *

Street Address 2

City *

State *

Zip Code *

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