HomeMy WebLinkAboutInv# 1157296400 - CONCENTRA MEDICAL CENTERS - 10/23/2024Concen era°
INVOICE
Occupational Health Centers
Remit To: of the Southwest, P.A.
PO Box 82549
Hapeville, GA 30354-0549
Tax Id: 75-2014828 (800)686-0468
Account: N33-1242003529 Invoice Date: 10/07/2024 - 10/11/2024
Invoice: 1157296400 Balance: $878.00 Date Printed: 10/14/2024
Bill TO:
Date
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 /
PO Number Birth date Description Amount Adjmnts
The Following Services Performed at
CMC - MIA Golden Glades
10/08/2024
Rambeau, Jabari E
XXX-XX-3881
Phys w/DFWP HIS 10 Pnl (FL Only)
PrePl
XX/XX/XXXX
DFWP UDS 27869 - 10 Panel (FL On
38.00
HPE Company Defined -Level 2
118.00
-
Physical Exam Concentra Standard
44.00
Breath Alcohol Test
41.00
The Following Services Performed at
CMC - MIA Ft
Lauderdale
-
10/07/2024
Cangialosi, Joseph S
XXX-XX-9590
DFWP UDS 10 Pnl (FL Only) & BAT
PostAcc
Xx/XX/Xxxx
Breath Alcohol Test
41.00
DFWP UDS 27869 - 10 Panel (FL On
38.00
10/08/2024
Espinosa, Jesse
XxX-XX-
DOT
PrePl
xX/Xx/xXXX
DOT Physical
124.00
10/11/2024
Adams, Emilee J
XXX-XX-5135
Phys w/DFWP HIS 10 Pnl (FL Only)
PrePl
XX/XX/XxxX
Breath Alcohol Test
41.00
DFWP HIS 27869 - 10 Panel (FL On
38.00
HPE Company Defined -Level 1
94.00
Physical Exam Concentra Standard
44.00
The Following Services Performed at
CMC - MIA Commercial Blvd
10/08/2024
Crowley, Tim S
XXX-XX-2379
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
APE Company Defined -Level 1
94.00
Physical Exam Concentra Standard
44.00
Balance Due: $878.00
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: 10/07/2024 - 10/11/2024 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