HomeMy WebLinkAboutInv# 1156082782 - CONCENTRA MEDICAL CENTERS - 01/30/2023Conceniira
Tax ld: .75-2074828
Account: N33-L24200352gInvoice: 11560}2l 82 Balance:
Bill To: ciry of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, EL 33004-3643
PLEASE
Name /Date PO Number
Remit To:
Invoice Date:
Date Printed:
Charge
Description
Occupational Health Centers
of the Southwest, P.A.
PO Box 82549
Hapeville, cA 30354-0549
(800) 686-0468
0t/L8/2023 - 07/2t/2023
07/23/2023
Charge
Amount
Pmts /
Adjmnts
INVOICE
$246 .00
RETURN THIS
ssN /
Birth date
LOcatiOn: City of Dani-a Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, EL 33004-3643
PORTION WITH YOUR REMITTANCE.
The Following Services Performed
07/78/2023 Spencer, Angela
The Following Services Performed at CMC - MIA Et
07/19/2023 Stone, Kevin XXX-XX-5647
xx/xx/xxxx
0l/27/2023 Karge, Evan G XXX-XX-
xxlxxlxxxx
at CMC - MIA Cypress Creek
XXX-XX-0590 Phys-T,v1 2 w/Non Reg UDS 5 pn1
XXlxXlXXxX Non Regulated UDS 5 panel 272L5*
Physical-Level 2
Lauderdale
Phys-Lvl 2 w/Non Reg UDS
Physical-Level- 2
Non Regulated UDS 5 Panel
Phys-Lv1 2 w/Non Reg UDS
Non Regulated UDS 5 Panef
Physical-Leve1 2
38.00
44 .00
5 Pn1
21 275*
5 Pnl
21 215*
44.00
38.00
38.00
44.00
Balance Due:s246.00
Wffi
Occupational- Health CentersKemlt lO: of the Southwest, p.A.
Accounfi N33-1242003529
lnv Date: ot/te/2023 - ot/2L/2023
We appreciate your business. You can now pay onl_ine athttps: //payments. concentra.com/. Online payments must be
made 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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