New Provider Networks Consultants 2019 Meet and Greet Question Title * 1. Name: OK Question Title * 2. Practice Name: OK Question Title * 3. Tax ID: OK Question Title * 4. Payee NPI: OK Question Title * 5. Email Address: OK Question Title * 6. Office Phone Number: OK Question Title * 7. Specialty: Primary Care Pediatrics OB-GYN Dental Hospital Other (please specify) OK From the list below, choose the city, date and time that best fits your schedule: OK Question Title * 8. Selma Date: January 3, 2019Place: Vaughan Regional Medical Center, 1015 Medical Center Parkway, Selma, AL 36701; medical office building classroom located in the tower next to the hospitalTime: 9 - 11 a.m. or 1 - 3 p.m. OK Question Title * 9. Alexander City Date: January 8, 2019 Place: Russell Medical Center (Professional Building), 3316 Highway 280, Alexander City, AL 35010 Time: 9 - 11 a.m. or 1 - 3 p.m. OK Question Title * 10. Gadsden Date: January 9, 2019 Place: Gadsden Regional Medical Center, 1007 Goodyear Avenue, Gadsden, AL 35903; 1st Floor Classroom – POB 500 Time: 10 a.m. - 2 p.m. OK Question Title * 11. Centreville Date: January 9, 2019 Place: Bibb Medical Center, 208 Pierson Avenue, Centreville, AL 35042 Time: 9 - 11 a.m. or 1 - 3 p.m. OK Question Title * 12. Carrollton Date: January 11, 2019 Place: Pickens County Medical Center, 241 Robert K. Wilson Drive, Carrollton, AL 35447 Time: 11 a.m. - 2 p.m. OK Question Title * 13. Florence Date: January 15, 2019 Place: ECM East Community Learning Center and Shoals Hospital, 2111 Cloyd Boulevard, Florence, AL 35630 Time: 9 - 11 a.m. and 1 - 3 p.m. OK Question Title * 14. Anniston Date: January 15, 2019 Place: Anniston City Meeting Center, 1615 Noble Street, Anniston, AL 36201 Time: 10 a.m. – 2 p.m. OK Question Title * 15. Sylacauga Date: January 15, 2019 Place: Coosa Valley Medical Center, 315 West Hickory Street, Sylacauga, AL 35150 Time: 9 - 11 a.m. or 1 -3 p.m. OK Question Title * 16. Cullman Date: January 17, 2019 Place: Cullman Civic Center Room 3 & 4, 510 5th Street SW, Cullman, AL 35055 Time: 9 - 11 a.m. and 1 - 3 p.m. OK Question Title * 17. Fort Payne Date: January 22, 2019 Place: DeKalb Regional Medical Center (Overflow Dining Room), 200 Medical Center Drive, Fort Payne, AL 35968 Time: 10 a.m. – 2 p.m. OK DONE