HomeMy WebLinkAboutInv# 1156146144 - CONCENTRA MEDICAL CENTERS - 03/07/2023Concenaira
Tax ld: 1-5-2OL4B2BAccount: N33-1242003529lnvoice: rt56!46144 Balance:
Bill To: ciry of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, EL 33004-3643
PLEASE
Name /Date PO Number
INVOICE
$246.00
Remit To:
Invoice Date:
Date Printed:
Occupational- Heafth Centers
of the Southwest, P.A.
PO Box 82549
Hapevi-1le, GA 30354-0549
(800) 686-0468
02/ 22 / 2023 - 02/ 24 / 2023
02/27 /2023
RETURN THIS PORTION WITH YOUR REMITTANCE.
SSN / Charge
Birth date Description
Location: City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, FL 33004-3643
Charge
Amount
Pmts /
Adjmnts
The Eol-lowing Services Performed
02/24/2023 Riera, Elora
PrePl
The Followj-ng Servj-ces Performed
02/22/2023 Colston, Lavonne
PrePl
The Foflowing Services Performed
02/23/2023 Wi11i-ams, Torian S
PrePI
at CMC - MIA Doraf
xxx-xx- 8 6 95
xx,/xx/xxxx
at CMC - MIA Ft
xxx-xx- 0 60 8
xx/xxlxxxx
Phys-Lvl 2 w/Non Reg UDS
Non Regulated UDS 5 Panel-
Physical Customer Defined
Lauderdal-e
Phys-Lv] 2 w/Non Reg UDS
Non Regulated UDS 5 Panel
Physical Customer Defined
5 PnI
21275
Level
5 Pnl
21 275
Levef
38.00
44.00
38.00
44.00
at CMC - MIA Commercial Bfvd
xxx-xx-0 900
xxlxx,/xxxx
Phys-Lvl 2 w/Non Reg UDS 5 Pnl
Non Regulated UDS 5 Panel 2'7215
Physical Customer Defined Level
38.00
44.00
Balance Due:s246.00
Occupationaf Health Centers
Remit To: of tire Southwest, p.A.
Account: N33-L242003529
lnv Date: 02/22/2023 - 02/24/2023
We appreciate your business. You can now pay onfine 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.
AAIEEO Employer PAYMENT DUE UPON RECEIPT
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