HomeMy WebLinkAboutInv# 1157308516 - CONCENTRA MEDICAL CENTERS - 10/29/2024Concentm
Taxld: 75-2014828
Account: N33-1242003529
Invoice: 1157308516
Balance: $641.68
INVOICE ,0(aIo'
Occupational Health Centers
Remit TO: of the Southwest, P.A.
PO Box 82549
Hapeville, GA 30354-0549
(800) 686-0468
Invoice Date:
10/15/2024 - 10/17/2024
Date Printed: 10/21/2024
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 J
Date PO Number
Birth date
Description
Amount Adjmnts
The Following Services Performed at
CMC - MIA Doral
10/17/2024 Vasquez, Francisco C
XXX-XX-
Phys w/DFWP UDS 10 Pnl (FL Only)
PrePl
XX/XX/XXXX
DFWP UDS 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 Ft
Lauderdale
10/15/2024 Espinosa, Jesse
XXX-XX-
Phys w/DFWP UDS 10 Pnl (FL Only)
PreP1
XX/XX/XXXX
HPE Company Defined -Level 3
144.00
10/17/2024 Bacarossi, Biancamaria
XXX-XX-4248
DFWP UDS 10 Pnl (FL Only) &. BAT
PostAcc
XX/XX/XXXX
Breath Alcohol Test
41.35
DFWP UDS 27869 - 10 Panel (FL On
39.29
The Following Services Performed at
CMC - MIA Sawgrass
10/16/2024 Kattak, Edmund N
XXX-XX-9516
Phys w/DFWP UDS 10 Pnl (FL Only)
PrePl
XX/XX/XXXX
Breath Alcohol Test
41.00
HPE Company Defined -Level 2
118.00
Physical Exam Concentra Standard
44.00
DFWP UDS 27869 - 10 Panel (FL On
38.00
Balance Due: $641.68
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: 10/15/2024 - 10/17/2024 made via credit card. Please contact our Central Business
Office at 800-686-0468 for additional information.
Page: 1/1
AA/EEO Employer PAYMENT DUE UPON RECEIPT