HomeMy WebLinkAboutInv# 1155913554 - CONCENTRA MEDICAL CENTERS - 10/28/2022Conceniira'
Tax ld: '15-20L4828
Account: N33-1242003529
lnvoice: 1155913554 Balance: $88.00
Bill To: city of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Bfvd
Dania, FL 33004-3643
INVOICE
Remit To:
lnvoice Date:
Date Printed:
Location:
Occupationaf Health Centers
of the Southwest, P.A.
PO Box 82549
Hapeville, GA 30354-0549
(800) 686-0468
to / 1r/2022 - 70/ t7/2022
70/1.1/2022
City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, FL 33004-3643
PLEASE RETURN THIS PORTION WITH YOUR REMITTANCE'
Name /
PO Number
ssN /
Birth date
Charge
Description
Charge
Amount
Pmts /
Adjmnts
Date
The Followingr Services Performed at
70/tt/2022 HoPkins, Lucia
CMC - MIA Pompano Beach
xxx-xx-0969
xx/xx/xxxx
Non Reg UDS 5 PnI &
Breath AIcohoI Test
Non Reg UDS 5 Panel
BAT Post Acc
Post Acciden 53.00
Post Acciden 35.00
Balance Due: $88 .00
Remit To:
Account:
lnv Date:
Occupational Health Centers
of the Southwest, P.A.
N33-1242003529
LO / L!/2022 - t0 / Lt/2022
We appreciate your business ' You can now pay online at
https-://paymenls.concentra 'com/ ' online payments must be
made via credit card. PIease contact our Central Business
oiii.. at BO0-686-0468 for additional information'
AA/EEO EmPloYer PAYMENT DUE UPON RECEIPT
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