4568 Ledbetter Ave.
Pawtucket, RI 34658
(800) 829-0580
Fax: (937) 438-5470
 |
||
| Card Number |
Amount |
|
| Signature |
Expiration Date |
|
| Statement Date |
Pay This Amount |
Account # |
| Billing Dept. Reba Santiago | Amount Paid | |
Addressee
Sandberg, Bobby
1345 Main St.
Pawtucket, RI 34658
Remit To
Pawtucket Plastic Surgeons, Inc.
4568 Ledbetter Ave.
Pawtucket, RI 34658
(800) 829-0580
|
|||||||||||||||
| 8/16/2005 8/16/2005 8/20/2005 8/16/2005 8/16/2005 8/16/2005 8/16/2005 9/1/2005 |
|
Dr. Amy Lee Dr. Steven Scott Dr. Amy Lee Dr. Amy Lee Dr. Amy Lee Dr. Steven Scott Dr. Amy Lee Dr. Amy Lee |
Octoplasty Anethesia - General Injection Hospital Fee Finance Charge Ploxyglobin Patient Payment Insurance Adjustment |
$3,998.00 $245.33 $33.26 $56.24 $22.11 $462.87 |
$4,000.00 $817.81 |
$0.00 |
$0.00 |
||||||||
|
Patient Aged Receiveables |
Due From Patient |
$0.00 |
|||||||||||||
| 0-30 Days |
30-60 Days |
60-90 Days | 90 + Days | Insurance Pending |
$0.00 |
||||||||||
| $0.00 | $0.00 | $0.00 | $0.00 | Account Balance |
$0.00 |
||||||||||
Pawtucket
Plastic Surgeons, Inc .
4568 Ledbetter Ave .
Pawtucket, RI 34658
(800) 829-0580
| Next Appointment: |
None Scheduled |