HomeMy WebLinkAboutInv# 1155783774 - CONCENTRA MEDICAL CENTERS - 08/15/2022VOIGE
(
PLEASE RETURN THIS PORTION
ssN /
Birth date
Conceniira"
Tax ld: j5-20L4828
Account: N33-t242003529
lnvoice: 1155783774
Remit To:
lnvoice Date:
Date Printed:
WITH YOUR REMITTANCE.
Charge
Description
Occupational Health Centers
of the Southwest, P.A.
PO Box 82549
Hapeville, GA 30354-0549
(800) 686-0468
0B / 03 /2022 - 0B/ 05/2022
08/08/2022
N&
Bill To: ci rrr
Attn:
of Dania Beach
Linda Gonzalez
100 W Dania Beach BIvd
Dania, EL 33004-3643
Name /
PO Number
Location: City of Dania Beach
Attn: Linda Gonzafez
100 W Dania Beach Bfvd
Dania, FL 33004-3643
Date
Charge
Amount
Pmts /
Adjmnts
The FoIlowing Servi-ces Performed at CMC - MIA Pinecrest
OB/03/2022 SaIz, Benjamin
The EoIl-owing Services Performed at
0B/05/2022 Ramos, Sandra
xxx-Xx-0967 Phys-Lv] 2 w/Non Reg UDS
XXIXXIXXXX Physical-Levef 2
Non Regulated UDS 5 Panel
CMC - MIA Et Lauderdale
xxx-xx-8664 Phys-Lvl 2 w/Non Reg UDS
xxlxx,/xxxx Non Regulated UDS 5 Panel-
Physj-cal-Level 2
5 Pn1
41.00
27275* 35.00
5 Pnf
2'12l-5* 35.00
41.00
Balance Due: $152 .00
Occupational Hea1th CentersRemit To: of tire southwest, p.A.
Account N33-1242003529
lnv Date: 0B/03/2022 - oB/05/2022
We appreciate your business. You can now pay online at
https : / /paymenLs . concentra. com/ . online payments must be
made via credit card. Please contact our Central- Business
office at 800-686-0468 for additional information'
AAIEEO Employer PAYMENT DUE UPON RECEIPT
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