HomeMy WebLinkAboutInv# 1155978743 - CONCENTRA MEDICAL CENTERS - 11/28/2022Concen{ire
Tax ld: 1 5-2ot4B2BAccount N33-1242003529
lnvoice: 1155978743 Balance: $76.00
Bill TO: City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, EL 33004-3643
INVOIGE
Remit To:
lnvoice Date:
Date Printed:
Occupational Health Centers
of the Southwest, P.A.
Po Box 82549
Hapevj-]le, GA 30354-0549
(800) 686-0468
rt/L1 /2022 - 77/ 71 /2022
71/21/2022
Location: City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, FL 33004-3643
Name /
PO Number
ssN /
Birth date
Charge
Amount
Pmts /
Adjmnts
PLEASE RETURN THIS PORTION WITH YOUR REMITTANCE.
Charge
DescriptionDate
The Eol-lowing Services Performed
Lt/l':, /2022 Parish, Samantha
at CMC - MIA Commercial Blvd
xxx-xx-2402 Phys-Lvl 2 w/Non Reg UDS
xxlxx/xxxx Non Regulated UDS 5 Panel
PhYsical-Level 2
5 Pnl21215* 35.00
41.00
Balance Due: $76.00
Remit To:
Account:
lnv Date:
Occupational Health Centers
of the Southwest, P.A.
N33-L242003s29
Lt/t1 /2022 - r!/11 /2022
Vie appreciate your business ' You can now pay onfine at
https: //payments. concentra ' com/ ' OnIine payments must be
madl via^ ciedit card. please contact our central Business
Offi-.. at BO0-686-0468 for additional information'
AAIEEO EmploYer PAYMENT DUE UPON RECEIPT
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