Laserfiche WebLink
1A1CIVIt:N1 <br />Filed for Record 12/29/2017 11:45:18 AM - Kittitas County, <br />Yakima Valley Radiology, P.C. <br />PO Box 2925 <br />Yakima WA 98907-2925 <br />A Audio <br />LWI <br />ElIjof <br />2290016 PEl <br />16 <br />CARD NUMBER. <br />SECURITI CODE <br />NAME ON CARD (PLEASE PRINT) <br />ESP. DATE <br />SIGNATURE <br />AMOUNT <br />STATEMENT DATE <br />10/20/2017 <br />ACCOUNT # <br />YVR246626 <br />PAP THIS AMOUNT <br />$50.00 <br />Office Hours: 8:00am - 4:00pm Monday - Friday Pay online at www.ePayitOnline.com <br />Phone: 509/248-6633 Toll Free: 800/510-5551 CodeID: YAKIMA11 Access #: 6602304-1-109 <br />Patient: SUZANNE HEATH RECTOR <br />I IIIIII VIII IIID VIII VIII ILII VIII VIII VIII VIII VIII II II IIT VIII VIII I I I I � I I I I � I II �� I � II <br />It <br />Ins.: KAISER GH NORTHWEST <br />1111111„I�I�IIII,II,II�IIIIIII�r11111111�I1nI,11�r11111111111 0551 <br />SUZANNE HEATH RECTOR YVR246626 <br />PO Box 366 <br />Ellensburg WA 98926-1913 <br />MAKE CHECK PAYABLE & REMIT TO: <br />1�111�1��11111111111111111111,1,111111111111111111111111111111��1 <br />Yakima Valley Radiology, P.C. <br />PO Box 2925 <br />Yakima WA 98907-2925 <br />0001 <br />05351 <br />AMOUNT PAI <br />YAKIMAI1-0569480-0000000.6602304.001-000109-#005515.0001 j DETACH HERE AND RETURN THIS TOP PORTION WITH YOUR PAYMENT <br />❑ PLEASE CHECK BOX IF ABOVE ADDRESS IS INCORRECT AND INDICATE CHANGES ON BACK. USING THE RETURN ENVELOPE ENCLOSED <br />DATE POST DATE CODE DESCRIPTION OF SERVICE CHARGE PAYMENT _ ADJ BALANCE - <br />09/12/17 93971 DUPLEX EXTREMITY VEINS UN <br />09/29/17 73718 MRI LOWER EXTREMITY NON J <br />10/19/17 KAISER GH NORTHWEST <br />To pay this statement electronically go to <br />inlnv.ePayitOnline,co7n 07- scan the barcode <br />to the right with your mobile device or tablet <br />$89.00 $89.00 <br />$177.00 $50.00 <br />$54.10 $72.90 <br />SCAN FOR 0� <br />MOBILE,} <br />PAYMENT <br />Total Balance: $139.00 <br />Insurance Pending: $89.00 <br />AMOUNT DUE NOW: $50.00 <br />Patient: SUZANNE HEATH RECTOR Account Number: YVR246626 Statement Date: 10/20/2017 <br />Location: KITTITAS VALLEY HEALTHCARE HOSP <br />Yakima Valley Radiology, P.C. <br />315 Holton Avenue, Suite 102 <br />Yakima WA 98902-3240 <br />YAKIMA11-0569480-0000000-6602304-001-000109-#005515.0001 Phone: 509/248-6633 Toll Free: 800/510-5551 IRS# 91-0861108 1 <br />