HomeMy WebLinkAboutInv# 1155826758 - CONCENTRA MEDICAL CENTERS - 09/12/2022Concen{ira
Tax ld: is-2oL4B2B
Account: N33-1242003529
lnvoice: 1155826758 Balance: $302.00
Bill To: City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, EL 33004-3643
INVOICE
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Remit To:
lnvoice Date:
Date Printed:
Occupatj-onal He
of the Southwes
PO Box 82549
Hapeville, GA 3
(B0o) 686-0468
0B/22/2022 - 0B
08/29/2022
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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 Blvd
Dani-a, EL 33004-3643
Charge
Amount
Pmts /
Adjmnts
Date
The Fo'l lowing Services Performed
OB/25/2022 HenleY, Mokieta L
The Following Services Performed
0B/22/2022 C1ark, AshIeY
The FoIlowing Services Performed
08/22/2022 Colfins, Roger J
0B/24/2022 Sanchez, Nicholas
at CMC - MIA CYPress Creek
xXx-XX-2570 DOT Phys PrePl w/Quest-Reg UDS C
xx/xx/xxxx DoT Physical PrePlacement
at CMC - MIA Golden Glades
xxx-xx- Phys-LvI 2 w/Non Reg UDS 5 Pnl
xxlxxlxxxx Non Regulated UDS 5 Panel 21275*
Physical-Level 2
at CMC - MIA Ft Lauderdale
XXX-XX-1963 Injury Care w/Non Reg UDS
xx/Xx/XxXX Non Reg UDS 5 PaneL Post
xxx-Xx-5389 Phys-LvI 2 w/Non Reg UDSxxlxx/xxxx I;;=l:3liili3ru3' 5 Panel
115.00
35.00
35.00
41.00
Balance Due: $302.00
35.00
41.00
5 Pnl
Acciden
5 PnI
2'7 275*
Occupat.ional Health Centers
Remit To: of tiLe SourhwesL, p . A.
Account: N33-1242003529
lnv Date: oB/22/2022 - aB/25/2022
We appreciate your business. You can now pay onfine at
httpi-: /,/paymenLs.concentra.com/. online payments must be
made via- ciedi-t card. PleaSe contact our Central Business
office at 800-686-0468 for additional information'
AAIEEO Employer PAYMENT DUE UPON RECEIPT
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