iEXCHANGE® Web Password Reset Form

   

Note: Provider includes Physician, Other Professional Provider and Facility Provider

  * Indicates a required field
* National Provider Identifier (NPI) Number:
* Provider Name:
* Primary Specialty:
* Address:
* City/State/Zip: / /
* Provider Office Phone Number: / /
* Contact Name:
* Contact Phone Number: / /
* Contact Fax: / /
* Contact E-mail Address:
* Current iEXCHANGE User ID:

Once you have completed all of the above required fields, click on "Submit".
   
   

Note: The Texas iEXCHANGE Support Desk will email your Account Administrator your iEXCHANGE ID, User ID and temporary password. Please allow five (5) business days for processing.

Updated 6-2008