Billing Version 0.0089897

Charge Exception Type

Company
Code
Practice
Location
Provider
Exception
Type
Record
ID
EMR Patient
Number
First Name
Last Name
Date of
Birth
Address
City
State
Zip
Code
Phone
Date of
Service
CPT
Code
Transaction
Date
100 BMS Practices BMS Location BMS Provider Patient 00878 0034535354 James Miller 11/10/1976 33, Crossings Road Upland CA 89789 787-909-8987 07/07/2016 00898 06/09/2016
100 BMS Practices BMS Location BMS Provider Patient 00878 0034535354 James Miller 11/10/1976 33, Crossings Road Upland CA 89789 787-909-8987 07/07/2016 00898 06/09/2016