HomeMy WebLinkAboutInv# 1155797188 - CONCENTRA MEDICAL CENTERS - 08/23/2022Concen+tra'
Tax ld: 1s-2oL4g21Account: N33-1242003529
lnvoice: 1155797188
BillTo:City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Bfvd
Dania, EL 33004-3643
PLEASE
Name /
PO Number
Location:
RETURN THIS PORTION WITH YOUR REMITTANCE.
Charge
Description
Occupational Health Centers
of the Southwest, P.A.
PO Box 82549
Hapeville, GA 30354-0549
(800) 686-0468
08 /12/2022 - 0B /t2/ 2022
0B/15/2022
City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, FL 33004-3643
Charge
Amount
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g lLllTv rnvoiceDate:
Balance: $35.b0 DatePrinted:
Date
ssN /
Birth date
Pmts /
Adjmnts
The EoIIowing Services Performed
0B/12/2022 Baldie, TommY R
at CMC - MIA Ft Lauderdale
XXX-XX-1518 Injury Care w/Non Reg UDS 5 Pn1
xx/xx/xxxx Non Reg UDS 5 Panel Post Acciden 3s.00
Balance Due: $35.00
Occupational Health Centers
Remit To: o t tire sourhwesr, p. A.
Account: N33-1242003529
lnv Date: oB/12/2022 - oB/12/2022
We appreciate your business. You can now pay online at
https: //payments. concentra. com/. onfine palrments must be
made via credi-t card. Pfease contact our Central- Business
Office at 800-686-0468 for additlonal i-nformation.
AA/EEO Employer PAYMENT DUE UPON RECEIPT
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