HomeMy WebLinkAboutInv# 1155814659 - CONCENTRA MEDICAL CENTERS - 09/12/2022Concenlfra
Tax ld: '7 5-21L4B2BAccount: N33-1242003529
lnvoice: 1155814659 Balance: $76.00
Bill To: city of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, EL 33004-3643
INVOICE
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Occupationaf Health Centers
Remat To: of the Southwest, P.A.
PO Box 82549
HaPeville, GA 30354-0549
(800)586-0468
lnvoice Date: oB/t1 /2022 - 0B/11 /2022
Date Printed: oB / 22 / 2022
Location: City of Dania Beach
Attn: Linda Gonzalez
1OO W Dania Beach Blvd
Dania, EL 33004-3643
PLEASE RETURN TH!S PORTION WITH YOUR REMITTANCE.
Name /
PO Number
ssN /
Birth date
Charge
Description
Charge Pmts /Amount Adjmnts
Date
The Foflowing Services Performed
08/11 /2022 Caserta, Christina M
at CMC - MIA Commercial Bfvd
XXX-XX-O678 PhrYs-Lvl 2 w/Non Reg
xx/xx/xxxx Nc>n Regulated UDS 5
PhYsical-Leve1 2
UDS 5 PNl
PaneI 21275* 35.00
41.00
Bafance Due: $76.00
occuPational Health Centers
Remit To: of tire southwest, P . A.
Account N33-1242003529
lnv Date: oB /r'1 /2022 ' oB / 11 / 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 Centraf Business
Oifi.. at 800-686-0468 for additional information'
AA/EEO Employer PAYMENT DUE UPON RECEIPT
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