HomeMy WebLinkAboutInv# 1155888385 - CONCENTRA MEDICAL CENTERS - 10/28/2022Concen{tra
Tax !d: 15-2OI4B2BAccountr N33-1242003529
Invoice: 1155888385 Balance: $76.00
Bill To: Cj tv of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, FL 33004-3643
Date
INVOICE
Remit To:
lnvoice Date:
Date Printed:
Occupational Health Centers
of the Southwest, P.A.
PO Box 82549
Hapeville, GA 30354-0549
(800) 686-0468
09 /26/2022 - 09/26/2022
t0/03/2022
PLEASE RETURN THIS PORTION WITH YOUR REMITTANCE.
Name/ SSN/ Charge
PO Number Birth date Description
Location: City of Dania Beach
Attn: Li-nda Gonzalez
100 W Dani-a Beach Blvd
Dania, EL 33004-3643
Charge
Amount
Pmts /
Adjmnts
The Fol lowr-ng Servi-ces Perf ormed
09/26/2022 Escarria, Valerie
at CMC - MIA Plant.ation
XXX-XX- Phys-Lv1 2 w/Non Reg UDS 5
xx,/xxlxxxx Non Regulated UDS 5 Panef
Physical-Leve1 2
Pnf27275* 35.00
41.00
Balance Due:$76.00
'
,'olt(/'-
Remit To:
Account:
lnv Date:
Occupational Health Centersof the Southwest, p.A.
N33-1242003529
09 /26/2022 - 0e /26/2022
We appreciate your business. you can now pay onl-ine athttps : / /payments.concentra.com/. Online payments must bemade via credit card. please contact our Central BusinessOffice at 800-686-0468 for additional_ informati-on.
AA/EEO Employer PAYMENT DUE UPON RECEIPT
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