HomeMy WebLinkAboutInv# 1156120740 - CONCENTRA MEDICAL CENTERS - 02/22/2023Concenltre
Tax ld: 1s-20L482aAccount N33-1242003529
lnvoice: tt56t2o't 40 Balance: $38 .00
Bill To: cj-ty of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach BIvd
Dania, FL 33004-3643
INVOIGE
Remit To:
lnvoice Date:
Date Printed:
Occupatlonal Heafth Centers
of the Southwest, P.A.
PO Box 82549
Hapeville, GA 30354-0549
(800) 686-0468
02/ or/2023 - 02/07/2023
02/13/2023
Location: City of Dania Beach
Attn: Linda Gonzalez
1OO W Dania Beach BIvd
Dania, EL 33004-3643
PORTION WITH YOUR REMITTANCE.
Name /
PO Number
PLEASE RETURN THIS
SSN /
Birth date
Charge
Description
Charge
Amount
Pmts /
Adjmnts
Date
The EoIlowing Services Performed at CMC - MIA Pinecrest
02/OL/2023 Henrik, Alexis lnjury Care w/Non Reg UDS 5 P1l
llo., nlq UDS 5 Panel Post Acciden 38'00xxx-xx-4 92 5
xxlxx/xxxx
Balance Due: $38 .00
vlorl s
Remit To:
Account:
lnv Date:
Occupational Health Centers
of the Southwest, P.A'
N33-1242003529
02/ O1/2023 - 02 / 0L/ 2023
We appreciate your business' You can now pay online at
https://payment".ion"t"tta'com/' onlj-ne payments must be
made via credit card' PIease contact our Centraf Business
oiii.. at 800-686-0468 for additional information'
AAIEEO EmploYer PAYMENT DUE UPON RECEIPT
Page: l/7
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