HomeMy WebLinkAboutInv# 1155744528 - CONCENTRA MEDICAL CENTERS - 07/28/2022Concenitra'
Tax ld: '15-2ot4a21
Account: N33-'L242003529
lnvoice: LL55144528 Balance: $296.00
Bill To: city of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, EL 33004-3643
INVOIGE
Remit To:
lnvoice Date:
Date Printed:
Occupational Health Centers
of the Southwest, P.A.
PO Box 82549
HapeviIIe, GA 30354-0549
(Boo) 586-0468
o7 /L1/2022 - 07 / L7/2022
07 /18/2022
Name /
PO Number
PLEASE RETURN THIS PORTION WITH YOUR REMITTANCE.
SSN / Charge
Birth date DescriPtion
Location: city of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach BIvd
Dania, FL 33004-3643
Charge
Amount
Pmts /
Adjmnts
Date
The Following Services Performed
O7 /lL/2022 AdelkoPf, Brandon
01 /L1/2022 Henrj-k, Alexis
0'7 / Ll / 2022 Henrik, Al-exis
at CMC - MIA Ft
xxx-xx-
xx/xxlxxxx
xxx-xx-4 92 5
xx/xxlxxxx
xxx-xx- 4 92 5' xx/xx,/xxxx
Lauderdale
HPE ComPanY Defined-Lv\ 2
HPE CompanY Defined-Level 2
Phys-Lv1 2 w/Non Reg UDS 5 Pnl
llon Regulated UDS 5 Panel 272I5*
Physical-Level 2
HPE ComPanY Defined-Lvl 2
HPE)Company Defined-Level 2
110.00
35.00
41.00
110.00
Balance Due: $296. 00
7/
OccuPational HeaIth Centers
Remit To: of t'he southwest, P.A.
Account: N33-t242003529
lnv Date: fi /!7/2022 - 01 /11/2022
We appreciate your business' You can now pay online at
frttpi^t ,/,/paymenls. concentra. com/ ' online payments must be
madl via- ciedit card. Please contact our Central Business
office at 800-686-0468 for addlti-ona1 lnformation'
AA/EEO Employer PAYMENT DUE UPON RECEIPT
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