HomeMy WebLinkAboutInv# 1208025911 - CONCENTRA MEDICAL CENTERS - 11/18/2024Concen m
Taxld: 75-2014828
Account: N34-1257261779
Invoice: 1208025911 Balance: $120.00
INVOICE
Remit To:
Invoice Date:
Date Printed:
occupational Health Centers
of the Southwest, P.A., Co.
PO Box 20127
Cranston, RI 02920-0942
(800)285-9795
11/01/2024 - 11/01/2024
11/06/2024
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 - MAS Wilmington
11/01/2024 Ciguene, Maudeline J XXX-XX-3854 Non Reg UDS 10 Pnl 120.00
PreP1 XX/XX/XXXX Non Reg UDS 27803 - 10 Panel
Balance Due: $120.00
Occupational Health Centers
Remit To: of the Southwest, P.A., Co. We appreciate your business. You can now pay online at
Account: N34-1257261779 https://payments.concentra.com/. Online payments must be
Inv Date: 11/01/2024- 11/01/2024.. made via credit card.. Please contact.our Central Business.
office at 600-285.'-9795 for additional. information.. ---
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nn/EEOEmployer PAYMENT DUE UPON RECEIPT