example - pa supervised w600000 carrier zyz 2000 hydra ... · charles zavier, md xmen billing...
Post on 26-Jul-2020
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W600000Carrier ZYZ2000 Hydra RoadNew York, NY 10001
Wolverine, Hugo 10 17 1960
2619 Avenue North
Brooklyn NY NY
11235 555 5555555 111 1111111
G3000000
Wolverine^^^Hugo Y4 9900V13972
Carrier ZYZ
Signature on File
01 02 2020 431 454 01 03 2020 01 03 2020 01 20 20200B 272222
DQ Charles Xavier, MD 1666699999
REFX5PA016182-8^^^G2PHYAS^^^PWK09EAC00985621^^^NTEADD20200302
0M5020
0B 944444
01 20 20 01 20 20 11 99213 A 70 24 1 9877777777
211111110 WH002345 70 24222 2222222
Charles Zavier, MD XMen Billing Services490 Western Ave 200 Shore Drive
Jean, Gray PA Brooklyn NY 11235 Great Neck NY 1234501/20/2020 1666699999 1666699997
987-65-4321
XFactor Tactical Support
94 Jamaica Drive
Jamaica
11422
EXAMPLE - PA SUPERVISED
X
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