HomeMy WebLinkAboutInv# 1156132896 - CONCENTRA MEDICAL CENTERS - 03/01/2023Concentra
Tax ld: 15-2ot4B2BAccount N33-1242003529
lnvoice: 1156132896 Balance: $95.00
Bil! To: city of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, EL 33004-3643
INVOICE
Remit To:
lnvoice Date:
Date Printed:
Occupational Heal-th Centers
of the Southwest, P.A.
PO Box 82549
Hapeville, GA 30354-0549
(800) 686-0468
02/1-3/ 2023 - 02/ 73 / 2023
02/20/2023
Location: City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, FL 33004-3643
PLEASE RETURN THIS PORTION WITH YOUR REMITTANCE.
Date
Name /
PO Number
ssN /
Birth date
Charge
Description
Charge
Amount
Pmts /
Adjmnts
The Following Services Perfogllqd
02/L3/2023 Grant, MitcheIl
PostAcc
at CMC - MIA Ft Lauderdale
XXX-XX- Non Reg UDS 5 PNL &
xxlxxlxxxx Non Regulated UDS 5
Breath Alcohol- Test
38.00
57.00
Balance Due: $95 . 00
BAT
Panel 2'7275
occuPational HeaIth Centers
Remit To: of t^he Southwest, P . A.
Account: N33-1242003529
lnv Date: 02/L3/2023 - 02/L3/2023
We appreciate your business' You can now pay online at
httpi-://paymenls.concentra'com/' Online payments must be
madl via- cledit card. pfease contact our central Business
office at 800-686-0468 for additional information'
AA/EEO EmploYer PAYMENT DUE UPON RECEIPT
Page: L/L