I would change Mailing Address to Billing Provider Info because that information goes in to Box 33 on the HCFA and it can't be a PO Box. We use a PO Box for our mailing address on file with the insurances. When I filled this information out for one of our providers I got thinking about if that was really for box 33. I called support and they confirmed. If there is a PO Box in there it will cause claims to reject or not process correctly. I would recommend using the verbiage that is on the HCFA so people will recognize the correct format and information. Location Address on the HCFA for Box 32 is labeled "Service Facility Location Information"
One thing to verify is on the zip codes. Every system I have used runs those digits together. So you might want to verify that have the - in there doesn't mess anything up on your side. It would be nice to be able add a provider to multiple locations/TIN. This will be a major headache for us since we have two locations and TIN. I also noticed the fields under the phone number accepts two formats either the phone number all ran together or using a dash. Does it matter the format on these?