Presbyterian Health Plan Letter of Interest Presbyterian Delivery System Hospital Credentials Verification Organization (CVO) Initial Application RequestCurrently selectedPay Hospital Application FeeHelpful Resources Home|Providers|Our Networks|Presbyterian Delivery System|Hospital Credentials Verification Organization (CVO)|Initial Application Request Initial Application Request Page Image Page Content Complete the online Request form below. Upon submission Presbyterian’s CVO will send a link to the email identified on the Initial Application Request to begin the AppCentral process. * = indicates required fields Type of Applicant: PHS Employed Non-Employed Locums Locums Agency Name* Desired Privilege Date* mm 1 2 3 4 5 6 7 8 9 10 11 12 dd 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 yyyy 2018 2019 2020 2021 2022 2023 First Name* Middle Initial/Name Last Name* Degree/Title* NPI Date of Birth* mm 1 2 3 4 5 6 7 8 9 10 11 12 dd 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 yyyy Provider Email Address* Provider Phone#* Provider Fax# Specialty* Select One Allergy & Immunology Anesthesiology Audiology Cardiology Colon and Rectal Surgery Counseling & Therapy Practice Dentist Dermatology Emergency Medicine Services Family Medicine Gastroenterology Internal Medicine Neurology Nuclear Medicine Obstetrics and Gynecology Occupational Medicine Oncology Ophthalmology Oral & Maxillofacial Surgery Orthopaedic Surgery Otolaryngology (ENT) Pathology Pediatrics Pharmacist Clinician Physical Medicine & Rehabilitation Physical Therapy Plastic Surgery Podiatry Preventive Medicine Psychiatry Psychologist Radiation Oncology Radiology Respiratory Care Social Worker Speech Language-Pathologist Surgery Thoracic Surgery Urogynecology Urology Other Other Specialty Sub-Specialty You must Select a Specialty First Area of Practice/Type of Privileges Select Presbyterian Facility* Presbyterian Hospital/Kaseman/Rust Medical Center (Albuquerque/Rio Rancho) Presbyterian Santa Fe Medical Center (Santa Fe) Plains Regional Medical Center (Clovis) Dan C. Trigg Memorial Hospital (Tucumcari) Española Hospital (Española) Lincoln County Medical Center (Ruidoso) Socorro General Hospital (Socorro) Special Instructions / Comments Credentialing Contact Full Name Credentialing Contact Phone# Credentialing Contact Email Completed By* Enter your full name. Contact Phone Number* Contact Email* The control cannot be rendered without valid Public and Private keys. Additional Content Back To Top Sidebar Content