HomeMy WebLinkAboutInv# 1155939089 - CONCENTRA MEDICAL CENTERS - 11/09/2022Concentra'
Tax ld: '75-2ot4A2B
Account N33-1242003529
lnvoice: 1155939089 Balance:
Bill To: City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach BIvd
Dania, FL 33004-3643
Date
PLEASE
Name /
PO Number
INVOIGE
Occupational Health Cente
Remit To: of the Southwest, P . A.
PO Box 82549
Hapevj-11e, GA 30354-05,
(800) 686-0468
Attn: Linda GonzaleZ I
100 W Dania Beach BIvd
Dania, EL 33004-3643
RETURN THIS PORTION WITH YOUR REMITTANCE.
SSN / Charge Charge PT..t I
Birth date Desciiption Amount Adjmnts
$ 2 4' o' T
"::,:
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The Potlowing Services -Performed at CMC - MIA Ft Lauderdale
:1O/25/2022 McCutcheon, Antiniquia XXX-XX-5518 Phys-Lvl 2 w/Non Reg UDS 5 Pn1
xxlxx/xxxx Non Regulated UDS 5 Pane] 212L5*
PhYsical-Level 2
LO/26/2022 McNeal, Gregory xxx-xx-5509 Non Reg UDS 5 Pnl & BAT Post Acc
xxlxxlxxxx Non Reg UDS 5 Panel Post Acciden
Breath Alcohol Test Post Acciden
3s.00
41.00
35.00
53.00
The Eollowing Services Performed at
I0/2'7/2022 Haney, Charles E
CMC - MIA Boca
Xxx-XX-0742 Phys-Lvl 2 w/Non Reg UDS 5 Pn1
xxlxxlxxxx Non Regulated UDS 5 Panef 21275* 35'00
PhYsical-Level 2 41'00
Balance Due: $240. 00
OccuPational Health Centers
RemitTo: ot t'i-,e Southwest, P.A.
Account N33-1242003529
lnv Date: to/25/2022 - 70/21 /2022
We appreciate your business. You can now pay online at
https-://paymenls.concentra.com/ . online payments must be
madl via- ciedi-t card. Please contact our Central Business
Office at 800-686-0468 for additional- information'
AA/EEO EmPloYer PAYMENT DUE UPON RECEIPT
Paqe: I /L