Mississippi Provider Portal - GHS eWebs

Registration

Welcome to the Mississippi Provider Portal Registration Page

By filling out this form, you are requesting access to the Mississippi Provider Portal

This information will be processed and verified. Please give us a couple of business days to finish processing your request

Required fields are marked by an asterisk (*).

User role . ( Changing the user role will modify the available fields in the form. Please review the form fields upon selecting a new role. )*:

Prefix:

First Name*:

MI:

Last Name*:

Postfix:

Title:

License Number*:

Pharmacy NPI*:

Medicaid ID*:

Please enter the identifier that is associated with your Medicaid ID. If you are unsure which identifier you used, it is acceptable to provide both. If you require assistance identifying this value, please call the Xerox Helpdesk at 1-800-884-3222.

SSN:

Tax ID:

Please note, the email address entered must be unique in the system. Multiple users registering with the same email address is prohibited.

Email*:

GHS Mississippi Provider Portal

Registration