MEDICARE: METROPLEX MOBLIE DIAGNOSTICS

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	247200000X	Other Technician	DC6715	TX

General Provider Information

NPI Number	:	1306968896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METROPLEX MOBLIE DIAGNOSTICS

Provider Business Mailing Address
First Line	:	4360 WESTERN CENTER BLVD PMB 175
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-2043
Country	:	US
Telephone Number	:	817-575-0113
Fax Number	:	817-581-2866

Provider Business Practice Location Address
First Line	:	4360 WESTERN CENTER BLVD PMB 175
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-2043
Country	:	US
Telephone Number	:	817-575-0113
Fax Number	:	817-581-2866

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JIMMY TODD RULAND
Credential	:	D.C.
Telephone Number	:	817-575-0113

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	08/22/2020

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