HomeMy WebLinkAboutInv# 1155467539 - CONCENTRA MEDICAL CENTERS - 02/28/2022Concenlfra
Tax ld: 15-zu.4B2BAccount N33-7242o03529
lnvoice: 11554 61539 Balance:
Bill To: city of Dania Beach
Attn: Llnda GonzaLez
100 w Dani-a Beach BIvd
Dania, FL 33004-3643
PLEASE
Name /
PO Number
Location: crty of Dania Beach
Attn: Lrnda Gonzalez
100 W Dania Beach BIvd
Dania, FL 33004-3643
RETURN THIS PORTION WITH YOUR REMITTANCE.
Date
Charge
Description
Charge Pmts /Amount Adjmnts
INVOICE
1l*M
SSN /
Birth date
Remit To:
lnvoice Date:
Date Printed:
occupational Health Centers
of the Southwest, P.A.
Po Box 82549
Hapeville, GA 30354-0549
(800) 685-0468
02/tB /2022 - 02/78/2022
02/27/2022
The Eoll-owing Services Performed
02/L8/2022 White, George
at CMC - MIA Ft Lauderdale
XXX-XX-2419 Non Reg UDS 5 Pn1 e
xx/xxlxxxx Breath Al-cohol- Test
Non RegUDS 5 Panef
BAT Post Acc
Post Acciden 53.00
Post Accident 35.00
Balance Due: $BB . 00
occuoational Health Centers
Remit To: of tire Southwesr, p . A.
Account N33-1,242003529
lnv Date: 02/tB/2022 - 02/78/2022
We appreciate your buslness. For your convenience we accept
all malor credit cards. Please reference the invoice number
when remitting payment. PLease contact our Central Busj-ness
office at 800-686-0468 for additional- information.
AAlEEO Employer PAYMENT DUE UPON RECEIPT
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