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	CONTACT US Midwest Medical Billing & Management 5745 Taft Pl. Merrillville, IN 46410 Voice: (219) 313-3123 Fax: (219) 884-0090 E-mail: Midwestmbm@sbcglobal.net Stephanie C. Johnson, RHIT,CPC Please enter your information in the fields below so we better evaluate your practice’s needs. Fields in bold are required Title/Name: Practice/Group Name: Specialty: How many providers are in your practice: [Select One]1-52-10 10-15 15+ Address: City: State: [Select One]AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashingtonWest VirginiaWisconsinWyoming Zip Code: E-mail: Contact Number: Best Time to Call: [Select One]Morning 8-12 Afternoon 12-4 Evening 4-8