HomeMy WebLinkAboutInv# 1156196753 - CONCENTRA MEDICAL CENTERS - 04/06/2023Conceniira'
INVOICE
Occupational Health Centers
Remit To: of the Southwest, p.A.
PO Box 82549
Hapeville, cA 30354-0549Tax ld: '75-2ot4a21 _ (800) 686-0468Account N33-124200352g lnvoice Date: o3/2t/2023 - 03/24/2023
lnvoice: 1156196753 Balance: $328.00 Date Printed: B/2j /2023
Bill To: City of Dania Beach
Attn: Linda Gonzafez
100 W Dania Beach Blvd
Dania, FL 33004-3643
Name /
Date PO Number
Location: City of Dania Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, FL 33004-3643
PLEASE RETURN TH!S PORTION WITH YOUR REMITTANCE.
ssN /
Birth date
Charge
Description
Charge Pmts /Amount Adjmnts
The Following Services Performed at CMC - MIA Golden Glades
03/23/2023 Lytch, Jenna E
PrePl
The Eollowing Services Performed at CMC - MIA Et Lauderdale
03/22/2023 Campa, Vivian E XXX-XX- Phys-LvI 2 w/Non Reg UDS 5 Pn1
XXX-XX-8106 Phys-LvI 2 w/Non Reg UDS 5 Pnl
xx/xx/xxxx Non Regulated UDS 5 Panel 2'721,5 38.00
Physical Customer Defined Level 44.00
xxlxxlxxxx Non Regulated UDS 5 Panel 2'7275 38.00
Physical Customer Defined Level 44.00
PrePl
The Eollowing Servlces Performed at CMC - MIA Sawgrass
03/21/2023 Guzman, Yeimy
PrePl
03/24/2023 Jackson, Joe
PrePl
{il"*A\b/
XXX-XX-3854 Phys-Lvl 2 w/Non Reg UDS 5 Pnl
xx/xx/xxxx Non Regulated UDS 5 Panel 21275 38.00
Physical Customer Deflned Level 44.00
xxx-xx-3337 Phys-LvI 2 w/Non Reg UDS 5 PnI
xxlxxlxxxx Non Regulated UDS 5 Pane1 272\5 38.00
Physical Customer Defined Level 44.00
Balance Due: S328. 00
Occupational Health CentersRemitTo: of tire Southwest, P.A. We appreclate your business. You can now pay online at
Account: N33-1242003529 https://payments.concentra.com/. onfine payments must be
lnv Datet 03/21/2023 - 03/24/2023 made via credit card. Please contact our Central Business
Office at 800-686-0468 for additional information.
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AAlEEoEmproyer PAYMENT DUE UPON RECEIPT