Provider Demographics
NPI:1609267871
Name:MEDCARE INFUSION SERVICES, INC
Entity Type:Organization
Organization Name:MEDCARE INFUSION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
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:305-863-8860
Mailing Address - Street 1:3085 W 80TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-3888
Mailing Address - Country:US
Mailing Address - Phone:305-863-4277
Mailing Address - Fax:786-513-3130
Practice Address - Street 1:3085 W 80TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-3888
Practice Address - Country:US
Practice Address - Phone:305-863-4277
Practice Address - Fax:786-513-3130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH279623336C0004X
FLPH124743336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102454000Medicaid
FL0490340001Medicare PIN