Provider Demographics
NPI:1013559590
Name:MEDCARE CENTERS, LLC
Entity Type:Organization
Organization Name:MEDCARE CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AGREDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-266-2929
Mailing Address - Street 1:5730 SW 74TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5300
Mailing Address - Country:US
Mailing Address - Phone:305-266-2929
Mailing Address - Fax:786-558-0242
Practice Address - Street 1:4767 NW 183RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2933
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:786-558-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104421800Medicaid