Field 2: BILLING SERVICE NAME If applicable, enter the name of the billing service that the provider is enrolled. with. If you are not using a billing service, leave this field blank. Field 3: DATE Enter the date the Certification Statement is submitted to the fiscal agent.
Gregory Jerome Coleman (born September 9, 1954 in Jacksonville, Florida) is a retired American football punter who had a 12-year career in the National Football League playing for the Cleveland Browns, the Minnesota Vikings, and the Washington Redskins. He attended Florida A&M University.
For the former Secretary of Agriculture, see Norman Jay Coleman. Norman Bertram Norm Coleman, Jr., (born August 17, 1949) is an American lobbyist, lawyer and politician. He served as a U.S. Senator from Minnesota from 2003 until 2009. Before that, he was mayor of Saint Paul, Minnesota from 1994 to 2002.