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Developing Provider Request

Starting a new hospice and not yet Medicare certified? The Developing Provider membership is the perfect way to engage with TNMHPO and build a solid foundation for your agency. Use this form to submit a developing provider request and we’ll be in touch soon. Approved developing providers will receive a one-year complimentary membership. For questions about completing this form, contact our team directly.

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Mailing Address (If different than physical address)


Primary Contact Person for TNMHPO Member Account*
Who should we ask for if questions come up about your TNMHPO member account?
If your organization uses a specific email address for patient intake, let us know and we will post this email address on your hospice locator page.
Key Staff List
Keep your staff in the loop on trainings, conferences, and hospice news from TNMHPO! When discipline-specific training and events come up, we will forward information directly to the appropriate staffer. (i.e. We Honor Veterans, chaplain training, billing conference, regulatory conference, etc.) We are happy to save administrators from endless email forwarding. You're welcome! Use the + button to add up to eight staff contacts.


Please list each county served by your organization, in alphabetical order. Avoid listing service area by regions, please, as the hospice locator tool relies on the county list. Thank you!

Organizational Structure

Organization Details
We want to better understand and effectively segment our membership. Please check all the apply:
Any additional information you want us to be aware of? Feel free to share it here.
The TNMHPO Developing Provider Membership is complimentary for one year.
The TNMHPO Education Subscription is an optional subscription: Train your whole staff - accessible all year - from our extensive online library. There's something for each hospice discipline. Membership Plus Education Subscription is just $650. For multi-site providers to qualify for an education subscription, each location with a different Medicare number (within the states of Texas or New Mexico) must be a member. Please note that education subscription pricing is per location.
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Education Subscription

The TNMHPO Education Subscription is for agencies who wish to provide on-demand education for the entire staff. This subscription is an add-on to a TNMHPO membership and can’t be purchased separately.

A TNMHPO Membership Plus Education Subscription gives members of the Texas New Mexico Hospice & Palliative Care Organization unlimited access to all archived online education for the entire year.  You can provide training to your current staff and utilize these educational opportunities for new employee orientation.  There are courses for every discipline on your hospice team and continuing education units and proof of attendance for Administrators, Nurses, Social Workers, and LPCs.

  • Over 100 recorded online training courses for all hospice disciplines
  • Eligible for Continuing Education Units
  • Customized certificates for CEUs
  • Available on-demand, on your schedule

The TNMHPO Education Subscription is 10% of your annual membership dues plus $650.  

When purchasing your membership, select the “Education Subscription” option in the drop down on the membership product page. 

Already a member? Contact our team directly to upgrade your membership.

For questions regarding our education subscription or its offerings, contact our Director of Operations, Keith Parker, at 512-956-0875 (voice and text) or email at kparker@txnmhospice.org.