HomeMy WebLinkAboutInv# 1157271237 - CONCENTRA MEDICAL CENTERS - 10/07/2024Concentra
Tax Id: 75-2014828
Account: N33-1242003529
Invoice: 1157271237 Balance: $458.00
INVOICE
Remit To:
Invoice Date:
Date Printed:
Occupational Health Centers
of the Southwest, P.A.
PO Box 82549
Hapeville, GA 30354-0549
(800)686-0468
09/24/2024 - 09/25/2024
09./30/2024
Bill To: City of Dania Beach
Location:
City of Dania Beach
Attn: Linda Gonzalez
Attn:
Linda Gonzalez
100 W Dania Beach Blvd
100 W
Dania Beach Blvd
Dania, FL 33004-3643
Dania,
FL 33004-3643
PLEASE
RETURN THIS
PORTION WITH YOUR REMITTANCE.
Name /
SSN /
Charge
Charge Pmts /
Date PO Number
Birth date
Description
Amount Adjmnts
The Following Services Performed at
CMC - MIA Commercial Blvd
09/24/2024 Permanan, Krystal K
XXX-XX-1259 Phys w/DFWP UDS 10 Pnl (FL Only)
PrePl
XX/XX/XXXX HPE Company Defined -Level 1
94.00
Physical Exam Concentra Standard
44.00
Breath Alcohol Test -
41.00
DFWP UDS 27869 - 10 Panel (FL On
38.00
The Following Services Performed at
CMC - MIA Sawgrass
09/25/2024 Haines, Amanda G
XXX-XX-1791 Phys w/DFWP UDS 10 Pnl (FL Only)
PrePl
XX/XX/XXXX Breath Alcohol Test
41.00
DFWP UDS 27869 - 10 Panel (FL On
38.00
HPE Company Defined -Level 2
118.00
Physical Exam Concentra Standard
44.00
Balance Due: $458.00
Occupational Health Centers
Remit To: of the Southwest, P.A. We appreciate your business. You can now pay online at
Account: N33-1242003529 https://payments.concentra.com/. Online payments must be
Inv Date: 09/24/2024 - 09/25/2024 made via credit card. Please contact our Central Business
Office at 800-686-0468 for additional information.
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AA/EEO Employer PAYMENT DUE UPON RECEIPT