HomeMy WebLinkAboutInv# 1156012944 - CONCENTRA MEDICAL CENTERS - 12/28/2022Conceniire
Tax ld: 1s-2Ot4B2BAccount: N33-1242003529fnvoice: 7L56012944 Balance:
Bill To: city of Dania BeachAttn: Linda Gonzalez
100 W Dania Beach Blvd
Dan.ia, EL 33004-3643
PLEASE
Name /Date PO Number
Remit To:
lnvoice Date:
Date Printedl
ssN /
Birth date
Charge
Description
Charge
Amount
Pmts /
Adjmnts
INVOICE
$152.00
LOCatiOn: City of Dania Beach
Attn: Linda Gonzafez
100 W Dani-a Beach Blvd
Dania, EL 33004-3643
RETURN THIS PORTION WITH YOUR REMITTANCE.
Occupatj-ona1 Health Centers
of the Southwest, P.A.
PO Box 82549
Hapeville, cA 30354-0549
(800) 685-0468
t2 / 09 / 2022 - 72/ 1.0 / 2022
72/72/2022
The Eollowing Servlces petformed
72/09/2022 Cardenas, Bryan
The Eollowing Services performed
12/70/2022 Roberson, Cedric D
Doral
Phys-Lv1 2 w/Non
Non Regulated UDS
Physical-Leve1 2
Lauderdale
Phys-LvI 2 w/Non
Non Regulated UDS
Physical-Level 2
e! CMC - MIA
VVY-VV-
xx/xx,/xxxx
at CMC - MIA Ft
xxx-xx-7 93 4
xxlxxlxxxx
Reg UDS 5 Pnl
5 Panef 21275*
Reg UDS 5 PnI
5 Panel 2'7215*
35. 00
41.00
35.00
41.00
Balance Due:$152.00
Remit To:
Account:
lnv Date:
Occupational HeaIth Centersof the Southwest, P.A.
N33-7242003529
12 /09 /2022 - L2/70 / 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 information.
AAIEEO Employer PAYMENT DUE UPON RECEIPT
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