MEDICARE: THE MEDICAL CITY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0206X	Mammography Clinic/Center
2	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1093093726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE MEDICAL CITY LLC

Provider Business Mailing Address
First Line	:	780 NW 42ND AVE STE 301
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-5536
Country	:	US
Telephone Number	:	786-422-6821
Fax Number	:	786-422-6855

Provider Business Practice Location Address
First Line	:	3595 W 20TH AVE STE 145
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4537
Country	:	US
Telephone Number	:	305-557-4424
Fax Number	:	305-557-4426

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ELIZABETH BRACERAS
Credential	:
Telephone Number	:	308-889-5332

Provider Enumeration Date	:	07/29/2011
Last Update Date	:	03/02/2026

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Directions to “THE MEDICAL CITY LLC ” Practice Location

Language	Start Address	Practice Location

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