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.
The Eagles defeated the Panthers 14-9. Mandatory Credit: Howard Smith-USA TODAY Sports. Kurt Coleman is a former member of the Philadelphia Eagles who was drafted in the seventh round of the 2010 NFL Draft. He came to the Minnesota Vikings this year to compete for a starting job.He is best known for his October 16, 2011 game against the Washington Redskins, where he intercepted Rex Grossman three times and was named Defensive Player of the Week. Harrison Smith is a fan favorite.e came to the Minnesota Vikings this year to compete for a starting job. He is best known for his October 16, 2011 game against the Washington Redskins, where he intercepted Rex Grossman three times and was named Defensive Player of the Week. Harrison Smith is a fan favorite.