Provider Demographics
NPI:1093093726
Name:THE MEDICAL CITY LLC
Entity Type:Organization
Organization Name:THE MEDICAL CITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-889-5332
Mailing Address - Street 1:3595 W 20TH AVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4533
Mailing Address - Country:US
Mailing Address - Phone:786-422-6821
Mailing Address - Fax:786-422-6855
Practice Address - Street 1:3595 W 20TH AVE STE 145
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4537
Practice Address - Country:US
Practice Address - Phone:305-557-4424
Practice Address - Fax:305-557-4426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography