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LOGIN REQUEST FORM
USER INFORMATION
Contact Name
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Email Address
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Phone Number
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ADDRESS INFORMATION
Address
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BAPTIST HEALTH URGENT CARE 3550 Springhill Dr. North Little Rock AR 72117 - Site ID: 12-04201
BAPTIST HEALTH URGENT CARE 3304 Commonwealth Dr. Braynt AR 72022 - Site ID: 12-04202
BAPTIST HEALTH URGENT CARE 1813 TP White Dr. Jacksonville AR 72076 - Site ID: 12-04203
BAPTIST HEALTH URGENT CARE 6805 Cantrell Rd. Little Rock AR 72207 - Site ID: 12-04204
BAPTIST HEALTH URGENT CARE 824 Military Rd. Benton AR 72015 - Site ID: 12-04205
BAPTIST HEALTH URGENT CARE 1902 Fayetteville Road. Van Buren, AR 72956 - Site ID: 12-04213
BAPTIST HEALTH URGENT CARE 402 W. Main St. Cabot AR 72023 - Site ID: 12-04206
BAPTIST HEALTH URGENT CARE 7600 Rogers Ave. Fort Smith AR 72903 - Site ID: 12-04207
BAPTIST HEALTH URGENT CARE - WESTLR 14524 Cantrell Rd. Suite 160 Little Rock AR 72223 - Site ID: 12-04208
HUNTSVILLE HOSPITAL URGENT CARE 210 Avalon Ave. Muscle Shoals AL 35661 - Site ID: 17-27101
HUNTSVILLE HOSPITAL URGENT CARE 900 Bob Wallace Ave. Ste 104 Huntville AL 35801 - Site ID: 17-27102
HUNTSVILLE HOSPITAL URGENT CARE 202 Cox Creek Parkway Florence AL 35630 - Site ID: 17-27103
HUNTSVILLE HOSPITAL URGENT CARE 1115 Beltline Road SE Suite 400 Decatur AL 35601 - Site ID: 17-27104
HUNTSVILLE HOSPITAL URGENT CARE 300 Hughes Rd Suite G2 Madison AL 35758 - Site ID: 17-27105
PHYSICIANS CARE 1494 Stuart Rd. Cleveland TN 37312 - Site ID: 14-42201
PHYSICIANS CARE 455 Chickamauga Dr. Ste 104 Dayton TN 37321 - Site ID: 14-42202
PHYSICIANS CARE 403 McBrien Rd. East Ridge TN 37412 - Site ID: 14-42203
PHYSICIANS CARE 4490 Hixson Pike Hixson TN 37343 - Site ID: 14-42206
PHYSICIANS CARE 524 Market Drive Lenior City TN 37771 - Site ID: 14-42207
PHYSICIANS CARE 625 E 12th St. S. Pittsburg TN 37380 - Site ID: 14-42208
PHYSICIANS CARE 400 Battlefield Pkwy. Ft. Oglethorpe GA 30742 - Site ID: 19-30101
PHYSICIANS CARE 1209 W. Walnut Ave Suite 1 Dalton GA 30720 - Site ID: 19-30102
PHYSICIANS CARE 1314 Turner McCall Blvd. Rome GA 30161 - Site ID: 19-30103
PHYSICIANS CARE - HAMILTON 2021 Hamilton Place Blvd. Chattanooga TN 37421 - Site ID: 14-42204
PHYSICIANS CARE - HWY58 4747 Hwy 58 Chattanooga TN 37416 - Site ID: 14-42205
PHYSICIANS CARE - NORTHSHORE 419 N. Market St. Ste 100 Chattanooga TN 37405 - Site ID: 14-42209
SHERWOOD URGENT CARE 610 Shepherd Way Searcy AR 72143 - Site ID: 09-04101
SHERWOOD URGENT CARE 1547 E. Harrison St. Batesville AR 72501 - Site ID: 09-04102
SHERWOOD URGENT CARE 222 Dave Ward Dr. Conway AR 72032 - Site ID: 09-04103
SHERWOOD URGENT CARE 1306 N. Center St. Lonoke AR 72086 - Site ID: 09-04105
SHERWOOD URGENT CARE 6134 Heber Springs Rd. Quitman AR 72131 - Site ID: 09-04106
SHERWOOD URGENT CARE 106 Weir Rd. Suite 4 Russellville AR 72801 - Site ID: 09-04107
SHERWOOD URGENT CARE 123 Audubon Dr. Suite 600 Maumelle AR 72113 - Site ID: 09-04108
SHERWOOD URGENT CARE 201 Airport Rd. Hot Springs AR 71913 - Site ID: 09-04113
SHERWOOD URGENT CARE - CONWAY N. 1065 Skyline Drive Conway AR 72032 - Site ID: 09-04112
URGENT TEAM 30 Burton Hills Blvd Suite 175 Nashville TN 37215 - Site ID: 02-42001
URGENT TEAM 2662 Memorial Blvd. Springfield TN 37172 - Site ID: 04-42107
URGENT TEAM 2395 Lake Rd. Dyersburg TN 38024 - Site ID: 04-42109
URGENT TEAM 1802 N. Jackson St. Ste 850 Tullahoma TN 37388 - Site ID: 04-42111
URGENT TEAM 15 Old Humboldt Rd, Ste D Jackson TN 38305 - Site ID: 04-42116
URGENT TEAM 1905 Gallatin Pk. North Madison TN 37115 - Site ID: 04-42117
URGENT TEAM 650 S. Jefferson Ave, Ste 101 Cookeville TN 38501 - Site ID: 04-42118
URGENT TEAM 8350 Hwy 64 Ste 103 Bartlett TN 38133 - Site ID: 04-42122
URGENT TEAM 509 Hillsboro Rd. Franklin TN 37064 - Site ID: 04-42123
URGENT TEAM 4723 Lebanon Pike Hermitage TN 37076 - Site ID: 04-42124
URGENT TEAM 2412 Lebanon Pike Nashville TN 37214 - Site ID: 04-42125
Urgent Team 555 Hwy. 6 East Batesville MS 38606 - Site ID: 06-24101
URGENT TEAM 3040 Goodman Rd. West Horn Lake MS 38637 - Site ID: 06-24102
URGENT TEAM 411 S. Falls Blvd. Wynne AR 72131 - Site ID: 09-04109
URGENT TEAM 500 Russell St. Suite 3 Starkville MS 39759 - Site ID: 10-25101
URGENT TEAM 1503 Hwy. 45 North Columbus MS 39705 - Site ID: 10-25102
URGENT TEAM 7474 Hwy 45 Alt N West Point MS 39773 - Site ID: 10-25103
URGENT TEAM 1154 Cross Creek Dr. Saltillo MS 38866 - Site ID: 10-25104
URGENT TEAM 525 W. Broadway Ave. Maryville TN 37801 - Site ID: 14-42210
URGENT TEAM 2636 W. Andrew Johnson Hwy Morristown TN 37814 - Site ID: 14-42211
URGENT TEAM 6944 Maynardville Pike Knoxville TN 37918 - Site ID: 14-42212
Urgent Team 30 Burton Hills Blvd Suite 175 Nashville TN 37215 - Site ID: Corporate
URGENT TEAM - E. NASH 3024 Gallatin Pike Nashville TN 37216 - Site ID: 04-42114
URGENT TEAM - FT, CAMP 1690 Fort Campbell Blvd. Clarksville TN 37042 - Site ID: 04-42113
URGENT TEAM - MURF MEM 2445 Memorial Blvd. Suite C Murfreesboro TN 37129 - Site ID: 04-42103
URGENT TEAM - MURF WEST 1144 Fortress Blvd Ste K Murfreesboro TN 37128 - Site ID: 04-42115
URGENT TEAM - SANGO 2224-B Madison St. Clarksville TN 37043 - Site ID: 04-42120
URGENT TEAM - ST. BETHLEHEM 2147 Wilma Rudolph Blvd. Suite 102 Clarksville TN 37040 - Site ID: 04-42119
URGENT TEAM - TINY TOWN 1466 Tiny Town Rd. Ste C Clarksville TN 37042 - Site ID: 04-42121
URGENT TEAM - VALERO 324 W. Mallory Ave. Memphis TN 38109 - Site ID: 06-24103
URGENT TEAM - 3980 Jiles Road, NW Kennesaw, GA, 30144 - Site ID: 19-30104
WASHINGTON REGIONAL URGENT CARE 2301 W. Pleasant Grove Rd Ste 101 Rogers AR 72758 - Site ID: 21-04301
WASHINGTON REGIONAL URGENT CARE 1301 S. Walton Blvd. Bentonville AR 72712 - Site ID: 21-04302
WASHINGTON REGIONAL URGENT CARE 808 US-65 Harrison AR 72601 - Site ID: 21-04303
WASHINGTON REGIONAL URGENT CARE 3300 W. Sunset Ave. Springdale AR 72762 - Site ID: 21-04304
APPROVER INFORMATION
DO/SM
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Aisha Anderson
Alyssa Fisher
April Goodloe
Arianna Heras
Belinda Bridges
Beverly Lovelady
Brandon Cole
Brian Miller
Belinda Bridges
Brittania Parker
Cindy Carter
Curt Marshall
Jason Burns
Jason Worley
Jennifer Caraway
Jennifer Still
Lisa Williams
Melissa Scurlock
Michelle Stevens
Nabil Keita
Payton Givens
Randa Bean
DVP Approver
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Ellis Harris - eharris@urgentteam.com
Mike Dupuis - mdupuis@urgentteam.com
Nancy Becker - nbecker@urgentteam.com
Joe House - jhouse@urgentteam.com
Does the Approver need access to print site?
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Yes
No
Which brands do they need access to?
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Notes