HomeMy WebLinkAboutInv# 1155771275 - CONCENTRA MEDICAL CENTERS - 08/11/2022Concentra
Tax ld: 15-2ot4B2B
Account: N33-1242003529
lnvoice: L7551':, 121 5 Balance: 5262.00
Bill To: City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Bl-vd
Danj-a, FL 33004-3643
INVOICE rltb-
Occupational Health Centers
of the Southwest, P.A.
PO Box 82549
Hapeville, GA 30354-0549
(800) 686-0468
o'7 /21 /2022 - 07 /28/2022
08/01/2022
Remit To:
lnvoice Date:
Date Printed:
Location: City of Dania Beach
Attn: Linda Gonzalez
1OO w Dania Beach Blvd
Dania, EL 33004-3643
PORTION WITH YOUR REMITTANCE.
Name /
PO Number
PLEASE RETURN THIS
ssN /
Birth date
Charge
Description
Charge
Amount
Pmts /
Adjmnts
Date
The Eollowing Servic." r:t_f-1t*:9
O't /28/2022 Chavez, Erank
O'l /28/2022 Chavez, Frank
The Eoltowing Services Performed
01 /27 /2022 HoPkins, Lucia
at CMC - MIA Et Lauderdale
Xxx-Xx-8766 Phys-Lvt 2 w/Non Reg UDS 5
xxlxx/xxxx ;;;"f3ili!i3rr?' 5 Paner
XxX-xX-8766 HPE Company Defined-Lv1 2
xxlxxlxxxx HPE Company Defined-Level
at CMC - MIA PomPano Beach
xXX-xX-0969 Phys-Lvl 2 w/Non Reg UDS 5
xxlxxlxxxx Non Regulated UDS 5 Panel
Physical-LeveI 2
PJ27215* 35.00
41.00
2 110.00
, Pn12'12L5* 35.00
41.00
Balance Due: 5262.00
occuPational Health Centers
Remit To: of t'he Southwest, P. A.
Account: N33-1242003529
lnv Date: 01 /21 /2022 - 01 /28/2022
We appreciate your business' You can now pay online at
https-:,//paymenls.concentra .com/ ' OnLine payments must be
madl via-ciedit card. please contact our central Business
office at 800-686-0468 for addi-tional information'
AAIEEO EmPloYer PAYMENT DUE UPON RECEIPT
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