HomeMy WebLinkAboutInv# 1156059066 - CONCENTRA MEDICAL CENTERS - 01/30/2023Concen{tra
Tax !d: 15-2OL4B2BAccount N33-t242003529lnvoice: 1156059066 Balance:
Bill To: Ciry of Dania Beach
Attn: Li-nda Gonzalez
100 W Dania Beach BIvd
Dania, FL 33004-3643
PLEASE
Name /Date PO Number
INVOICE
$133.00
Remit To:
lnvoice Date:
Date Printed:
Occupational Hea1th Centers
of the Southwest, P.A.
PO Box 82549
Hapeville, GA 30354-0549
(800) 686-0468
0t/04/2023 - 0t/04/2023
07/09/2023
RETURN THIS PORTION WITH YOUR REMITTANCE.
SSN / Charge
Birth date Description
LOCatiOn: City of Dania Beach
Attn: Li-nda Gonzalez
100 W Dani-a Beach Blvd
Dania, FL 33004-3643
Charge
Amount
Pmts /
Adjmnts
The Eollo:d-rlg Salvices Perfossed
01-/04/2023 Perez, Frank
0L/04/2023 ZapaLa, Marlon J
at CMC - MfA Ft Lauderdale
XXX-XX-0362 Injury Care w/Non Reg UDS 5 Pn1
XX,/XXlXxxX Non Reg UDS 5 Panel Post Acciden 38.00
Balance Due:$133.00
XXX-XX-9082 Non Reg UDS 5 Pnl & BAT Post Acc
Xx/xx/xxxK Breath Alcohol Test Post Acciden 57.00
Non Reg UDS 5 Panel Post Acciden 38.00
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Occupational- HeaIth CentersRemit To: of tire Southwest , p. A.Account N33-1242003529
lnv Date: ot/04/2023 - 07/04/2023
We appreciate your business. You can now pay online at
https://payments.concentra.com/. Online payments must be
made via credit card. Please contact our Central Business
Office at 800-686-0468 for additional information.
AA/EEO Employer PAYMENT DUE UPON RECEIPT
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