Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref