Bill To:

GEICO INSURANCE – MEDICAL
ONE GEICO BLVD
FREDERICKSBURG, VA 22412-9000

Services Rendered To:

Janie Rothrock
922 East Palestine
Mexia, Texas 76667
Policy # 4595590243


Product
Price
Qty
Amount

  1. 406 Medical Extrication – Lvl 2

    Patient:

    Janie Rothrock
    922 East Palestine
    Mexia, Texas 76667
    Policy # 4595590243

    $1,500.00
    1
    $1,500.00

    2. Additional Incident Info

    Incident Type: Select One

    Incident Location: Highway 14 - Richland, Texas

    Ordinance Info: Richland Billing Ordinance NO. 170 Cost Recovery

Subtotal $1,500.00
Total Due $1,500.00


Checks Payable To:

Sure Fire Recovery Service, LLC
9711 S Mason Road 125-120
Richmond, TX 77407
Federal Tax ID – 83-4417185


  Please Include Incident Number On All Correspondence.
Updated
May 14, 2021 @ 6:45 pm

Invoice updated by Geoffrey.

Updated
May 14, 2021 @ 6:46 pm

Invoice updated by Geoffrey.