HomeMy WebLinkAboutInv# 1156025600 - CONCENTRA MEDICAL CENTERS - 12/28/2022Conceniira
INVOICE
Occupationaf Heafth Centers
Remit To: of the Southwest, p . A.
PO Box 82549
Hapeville, cA 30354-0549
- Tax ld: 75-2otal2l (Boo) 686-0468Account: N33-t242OO3S2g lnvoice Date: 72 / 71 / 2022 - t2 / j,.7 / 2022lnvoice: 1156025600 Balance: 976. oO Date Printed: 72/t9/2022
Bill To: City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, FL 33004-3643
Name /
Date PO Number
LOCatiOn: City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach BIvd
Dania, FL 33004-3643
PLEASE RETURN THIS PORTION WITH YOUR REMITTANCE.
ssN /
Birth date
Charge
Description
Charge Pmts /Amount Adjmnts
The Folfowing Services Performed at CMC - MIA Et Lauderdale
1-2 / 11 / 2022 A1i, Rj-cky A XXX-XX-0750 Phys-Lv1 2 w/Non Reg UDS 5 Pnl
xx,/xxlxxxx Physical-Level 2
Non Regulated UDS 5 Panel 21275* 35.00
41.00
Balance Due: $76.00
L,5
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Occupational Health CentersKemlt lo: of Lhe Southwest, P.A. !!e appreciate your business. You can now pay online atAccount: N33-1242003529 httpi-:,//payments.concentra.com/. online payments must belnvDate: L2/l'7/2022 - 72/\1/2022 made via credit card. please contact our centraf BusinessOffice at B0O-686-0468 for additional information.
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AA/EEOEMPIOYCT PAYMENT DUE UPON RECEIPT