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11103 - March 20, 2024 -

Date

March 20, 2024

Repair Order

11103

Facility

Facility Name

Northwest Health La Porte

Contact Name

Bob Smith

Billing Name

Northwest Health - La Porte

Email Address

r.smith@nwhealthin.com

Phone Number

Shipping Address

1331 State Street

La Porte, IN 46350

United States

Billing Address

ATTN: AP COID 1591

United States

Equipment

PO #

215910000714-2

Manufacturer

Precision Medical

Model #

PM5300

Serial #

00030000

Asset Tag #

2448

Reported Failure

2 Year Blender Overhaul

Anything Else

n/a