MEDICARE: MIDTOWN MEDICAL IMAGING - FORT WORTH, 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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1033957667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDTOWN MEDICAL IMAGING - FORT WORTH, LLC

Provider Business Mailing Address
First Line	:	900 JEROME ST STE 104
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3939
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 HEMPHILL ST STE 120
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4714
Country	:	US
Telephone Number	:	817-768-5317
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGING MEMBER
Name	:	MR. BRADLEY SCOBLE
Credential	:
Telephone Number	:	817-768-5317

Provider Enumeration Date	:	07/17/2024
Last Update Date	:	07/17/2024

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