Providence Hospital - Billing Services Payment Coupon

The Payment Distribution Coupon allows patients to pay off several accounts with only one check or one credit card transaction. The coupon also offers patients an opportunity to request contact from one of our Customer Service Representatives for assistance with your accounts at the time that best suits your needs. To utilize the Payment Distribution Coupon
- click on the "Printable Coupon" link below and follow directions to download and print the coupon;
- complete the form, and be sure to write the account number(s) and the amount that you would like to pay on each account;
- present the coupon and payment in person OR mail the Payment Distribution Coupon with your check or credit card information to:
Providence Hospital and Medical Centers
P.O. Box 64051
Detroit, MI   48264-0051  

Note: This coupon is in PDF format and requires Adobe Acrobat Reader   

Printable Coupon