HomeMy WebLinkAboutInv# 1156371921 - CONCENTRA MEDICAL CENTERS - 07/12/2023Concenaira'
Tax Id: 15-2ot4B2BAccount: N33-1242003529lnvoice: tL563'11921 Balance:
Bill To: Cj,ty of Danj-a Beach
Attn: Linda Gonzalez
100 W Dania Beach BIvd
Dania, FL 33004-3643
PLEASE
Name /
Date PO Number
INVOICE
699.00
Remit To:
lnvoice Date:
Date Printed:
Occupational Health Centers
of the Southwest, P.A.
PO Box 82549
Hapevj-lle, GA 30354-0549
800) 686-0468
06/28/2023 - 07 /01/2023
0'7 /03/2023
RETURN THIS PORTION WITH YOUR REMITTANCE.
SSN / Charge
Birth date Description
LOCatiOn: City of Dani-a Beach
Attn: Linda Gonzalez
100 W Dania Beach Blvd
Dania, EL 33004-3643
Charge
Amount
Pmts /
Adjmnts
The Following Services Performed
O6/28/2023 Brathwaite, David
PrePl
The Following Services Performed
06/28/2023 Brown, Elisha
PrePf
The Eollowing Services Performed
06/29/2023 Cady, Jonathan
PrePl
The Eollowing Services Performed
0'7 / 01/ 2023 Scr j-vani, Lora
PrePl
at CMC - MIA Cypress Creek
xxx-xx-6143
xx/xx,/xxxx
at CMC - MIA Ft
xxx-xx-
xx/xxlxxxx
xxx-xx- 92 7 B
xx/xxlxxxx
at CMC - MfA Boca
XXX-XX-9879 Phys w/Non Reg UDS 5 Pnl- & HPE
xx/xx/xxxx HPE Company Defined-Levef 1
Non Reg UDS 21208 - 8 Panel
Physical Exam Concentra Standard
t
at CMC - MIA Sawgrass
Phys w/Non Reg UDS 5 Pnl & HPE
HPE Company Defined-Level 2
Non Reg UDS 2'7208 - B Panel
Physical Exam Concentra Standard
Lauderdale
Phys-LvI 2 w/Non Reg UDS 5 PnI
Non Reg UDS 21275 - 6 Panel
Physical Customer Defined Level
Phys w/Non Reg UDS 6 PnI & BAT
Breath Alcohol Test
Physical Exam Concentra Standard
Non Reg UDS 212L5 - 6 Panel
118.00
89.00
44.00
38.00
44.00
94.00
89.00
44.00
57.00
44.00
38.00
Balance Due: $699.00
1[ ttf
occupational HeaIth Centers
Remit To: of t'he southwest, p . A.
Account: N33-t242003529
lnv Date: 06/28/2023 - 01/or/2023
We appreciate your business. You can now pay online at
frttpi,//payments.concentra.com/. online payments must be
made via credit card. Please contact our central Business
office at 800-686-0468 for additional information'
AA,/EEO EmPloYer PAYMENT DUE UPON RECEIPT
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