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Pre-Application for Medical Staff/AHP Membership & Privileges

Man standing in front of medical staff

If you have not received a response to your Request for Initial Application submission after 7 business days, you may contact PHApplicationRequests@powershealth.org for a status update.

This request will be evaluated to determine if you meet facility criteria for membership and privileges. If you meet criteria, you will receive an application.

Name

Birthdate

Degree

Primary Office Address

Contact Information

Credentialing

Specialties

Medical School

Residency

Fellowship