MEDICARE: MID-CITIES IMAGING, L.P.

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	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist	R30811	TX

General Provider Information

NPI Number	:	1770610685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MID-CITIES IMAGING, L.P.

Provider Business Mailing Address
First Line	:	PO BOX 835885
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75083-5885
Country	:	US
Telephone Number	:	972-498-1963
Fax Number	:	972-498-1965

Provider Business Practice Location Address
First Line	:	1015 W RANDOL MILL RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-2513
Country	:	US
Telephone Number	:	817-701-1306
Fax Number	:	682-367-1770

Authorized Official
Title or Position	:	PARTNER
Name	:	MRS. ARDELLE K ARCHER
Credential	:
Telephone Number	:	972-498-1963

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/28/2014

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