HomeMy WebLinkAboutInv# 1155965052 - CONCENTRA MEDICAL CENTERS - 11/28/2022Concen{ire
Tax ld: j5-2Ot 4B2BAccount: N33-1242003529lnvoice: 1155965052 Balance:
Bill To: Ciry of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach BfvdDania, EL 33004-3643
PLEASE
Name /Date PO Number Charge
Amount
Pmts /
Adjmnts
INVOICE
$3s.00
RETURN THIS PORTION
ssN /
Birth date
Remit To:
lnvoice Date:
Date Printed:
WITH YOUR REMITTANCE.
Charge
Description
LOCatiOn: City of Dania BeachAttn: Li-nda Gonzalez
100 W Danla Beach Bfvd
Dani-a, FL 33004-3643
Occupatronal Health Centersof the Southwest, P.A.
PO Box 82549
HapevilIe, GA 30354-0549
(800) 686-0468
7t/70/2022 - tt/70 /2022
L7/14/2022
The Following Services performed
Lt/IO/2022 Rodriguez, Richard
at CMC - MIA Pt Lauderdale
XXX-XX-7577 rnjury Care w/Non Reg UDS 5 pn1
XXIXX,/XXXX Non Reg.UDS 5 panef post Acciden 35.00
Balance Due: S35. 00
Remit To:
Account:
lnv Date:
Occupational Heal-th Centersof the Southwest, p.A.
N33-7242003s29
t1-/ 70 /2022 - 77/ 70 /2022
We appreciate your business. you can now pay online athttps: //payments. concentra. com/ . On]ine piyments must bemade via credit card. pfease contact our centraf BusinessOffice at 800-686-0468 for additional- information.
AAIEEO Employer PAYMENT DUE UPON RECEIPT
Paoe: 1 /1