HomeMy WebLinkAboutInv# 1157321922 - CONCENTRA MEDICAL CENTERS - 11/07/2024Concen ra
Tax Id: 75-2014828
Account: N33-1242003529
Invoice: 1157321922 Balance: $945.22
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
10/21/2024 - 10/27/2024
10/28/2024
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
10/25/2024
Singh, Kevin N
XXX-XX-1842
DFWP UDS 10 Pnl (FL Only)
& BAT
PostAcc
XX/XX/XXXX
Breath Alcohol Test
41.39
DFWP UDS 27869 - 10 Panel
(FL On
39.29
10/25/2024
Singh, Kevin N
XXX-XX-1842
Injury Care w/DFWP UDS 10
Pnl (F
PostAcc
XX/XX/XXXX
DFWP UDS 27869 - 10 Panel
(FL On
39.29
/0/25/2024
Young, Robert A
XXX-XX-8291
Phys w/DFWP UDS 10 Pnl (FL
Only)
PrePl
XX/XX/XXXX
Breath Alcohol Test
41.39
DFWP UDS 27869 - 10 Panel
(FL On
39.29
HPE Company Defined -Level
2
122.01
Physical Exam Concentra Standard
45.50
./0/26/2024
Hope, Jeannette D
XXX-XX-7741
Phys w/DFWP UDS 10 Pnl (FL
Only)
PrePl
XX/XX/XXXX
Breath Alcohol Test
41.39
HPE Company Defined -Level
2
Physical Exam Concentra Standard
-122.01
�FS.SU
DFWP UDS 27869 - 10 Panel
(FL On
39.29
10/27/2024
Wise, Dillon K
XXX-XX-6889
DFWP UDS 10 Pnl (FL Only)
& BAT
PostAcc
XX/XX/XXXX
Breath Alcohol Test.
41.39
DFWP UDS 27869 - 10 Panel
(FL On
39.29
The Following
Services Performed at
CMC - MIA Sawgrass
W-10/26/2024
Desiderio, Zaira S
XXX-XX-1033
Phys w/DFWP UDS 10 Pnl (FL
Only)
PrePl
XX/XX/XXXX
Breath Alcohol Test
41.39
DFWP UDS 27869 - 10 Panel
(FL On
39.29
Physical Exam Concentra Standard
45.50
The Following
Services Performed at
CMC - MIA Pompano Beach
/10/21/2024 Yany, Megan R XXX-XX-8696
PrePl XX/XX/XXXX
Occupational Health Centers
Remit To: of the Southwest, P.A.
Account: N33-1242003529
Inv Date: 10/21/2024 - 10/27/2024
HPE Company Defined-Lvl 2
HPE Company Defined -Level 122.01
Balance Due:
$945.22
We appreciate your business. You can now pay online at
https://payments.concentra.com/. Online payments must be
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