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weberp. altosinc. com Apex Healthcare Medical Center Inc 41889 E Florida Ave Hemet, CA 92544-5042 United Healthcare 12 8 2020 005500020489 REFUND REQUEST Health Plan: Date of Service: Patient Account Case #: Patient Name: Health Plan ID #: Claim Paid on Check Dear Provider: Miguel Sanchez-ariola 950504201 177659392 nocheck 2 22 2021
INLAND FACULTY MEDICAL GROUP PAGE: 1 apex healthcare medical center svc date proc modifiers pos qty billed cntrct copay adjust code w hold int net total provider: panse milind membname: mcneil althea m membid: 19961108692500 claim #: 2022022283705502 plan: ieml 01 06 2022 20610 rt 11 1 136 00 68 69 0 00 68 00 12 0 69 0 00 0 00 0 00
Apex Healthcare Med Ctr Inc Ortho Division EFT-1281318 1225 E Latham . . . Apex Healthcare Med Ctr Inc Ortho Division EFT-1281318 1225 E Latham Ave Ste A HEMET, CA 92543-4423 VOID SIX MONTHS AFTER CHECK DATE 90-4150 1222 DATE: 06 02 2022 EFT-1281318 TO THE ORDER OF PAY: UNION BANK 400 California Street San Francisco, CA 94101 Two Thousand Eight Hundred Ninety-One And 77 100 Dollars
appeal - weberp. altosinc. com apex healthcare medical center 1225 e lathamave ste a hemet, ca 92543 date paid: check: tax id: 11 23 2021 1 - 203868 1447455423 - access first urgent care 40000061635500 - de jesus, lorena urgent care 006000099343 iehp me-di-cal primary nmim prov id name: nmm claim member id name: place of service: dx3:
Make Checks Payable To: IF PAYING BY CREDIT CARD, FILL OUT BELOW Apex . . . Apex Healthcare Medical Center -Ortho 41889 E Florida Ave Hemet, CA 92544-5042 USA IF PAYING BY CREDIT CARD, FILL OUT BELOW CHECK CARD USING FOR PAYMENT Mastercard Visa CARD NUMBER CVV AMOUNT SIGNATURE EXP DATE STATEMENT DATE 04 10 2020 PAY THIS AMOUNT $188 01 ACCOUNT NBR 0005000000032260 SHOW AMOUNT PAID HERE $ ADDRESSEE: Frances Wysocki 1590
appeal form eob MR merged (1) - weberp. altosinc. com APEX HEALTHCARE MEDICAL CENTER 1225 E LATHAM AVE, STE A HEMET, CA 92543 CHECK AMOUNT Check Number: Date: Amount $3,259 67 $3,259 67 $3,259 67 529528 02 25 2022 Paid Amount $3,259 67 3,259 67 Three Thousand Two Hundred Fifty Nine Dollars And 67 Cents Wells Fargo Bank, N A 420 Montgomery Street san Francisco, CA 94104
Make Checks Payable To: IF PAYING BY CREDIT CARD, FILL OUT BELOW Apex . . . Apex Healthcare Medical Center -Ortho 41889 E Florida Ave Hemet, CA 92544-5042 USA IF PAYING BY CREDIT CARD, FILL OUT BELOW CHECK CARD USING FOR PAYMENT Mastercard Visa CARD NUMBER CVV AMOUNT SIGNATURE EXP DATE STATEMENT DATE 06 18 2020 PAY THIS AMOUNT $42 00 ACCOUNT NBR 0005000000046376 SHOW AMOUNT PAID HERE $
APEX HEALTHCARE MEDICAL CENTER INC APEX HEALTHCARE MEDICAL CENTER INC: 391 N SAN JACINTO ST: HEMET, CA 92543 Provider #: 1972899839 Provider Tax ID #: 330990457 EFT #: 9775948100 NPI Group Provider Number: 1457472664 Check Date: 6 15 2022 Created Date: 6 14 2022 Check Amount: $135 23 Provider Adj Amt: $0 00 Patient Name: