Bill To:


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

Services Rendered To:


Cryslia Worthy
292 County Road 4678
Boyd, Texas 76023
Policy # 6046517428


Product
Price
Qty
Amount
  1. 406 Medical Extrication – Lvl 2

    Patient:

    Paydne Downing
    1035 Meadow Oaks
    Azle, Texas 76020

    $1,500.00
    1
    $1,500.00

  2. Additional Incident Info

    Incident Type: MVA Response

    Incident Location: Portwood Road & FM 730 North - Azle, Texas

Subtotal $1,500.00
Total Due $1,500.00


Updated
November 8, 2021 @ 1:45 pm

Invoice updated by Geoffrey.

Viewed
January 9, 2022 @ 8:54 pm

Invoice viewed by Karen Smith (KarenS) for the first time.