- Form #
- CMS 855S
- Form Title
- Medicare Enrollment Application - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers
- Revision Date
- 2013-01-01
- O.M.B. #
- 0938-0685
- O.M.B. Expiration Date
- 2015-12-31
- CMS Manual
- N/A
- Special Instructions
- N/A
