HomeMy WebLinkAboutInv# 1157286178 - CONCENTRA MEDICAL CENTERS - 10/18/2024Concen tray
Taxid: 75-2014828
Account N33-1242003529
Invoice: 1157286178 Balance: $29�.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
09/30/2024 - 09/30/2024
10/07/2024
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 Ft Lauderdale
09/30/2024
Williams, Darius B
XXX-XX-5133
DFWP UDS 10 Pnl (FL Only)
& BAT
PostAcc
XX/XX/XXXX
Breath Alcohol Test
41.00
09/30/2024
Williams, Darius B
XXX-XX-5133
Injury Care w/DFWP UDS 10
Pnl IF-
PostAcc
XX/XX/XXXX
DFWP UDS 27869 - 10 Panel
(FL On
38.00
The Following
Services Performed
at CMC - MIA Sawgrass
09/30/2024
Cuervo, Alejandra
XXX-XX-
Phys w/DFWP UDS 10 Pnl (FL
Only)
PreP1
XX/XX/XXXX
Physical Exam Concentra Standard
44.00
Breath Alcohol Test
41.00
DFWP UDS 27869 - 10 Panel
(FL On
38.00
HPE Company Defined -Level
1
94.00
Balance Due: $296.00
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: 09/30/2024 - 09/30/2024 made via credit card. Please contact our Central Business
Office at 800-686-0468 for additional information.
Page: 1/1
M/EEO Employer PAYMENT DUE UPON RECEIPT