MEDICARE: RAMIC 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871788224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAMIC FORT WORTH, LLC

Provider Business Mailing Address
First Line	:	750 12TH AVE STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2531
Country	:	US
Telephone Number	:	817-763-5900
Fax Number	:	817-763-5858

Provider Business Practice Location Address
First Line	:	750 12TH AVE STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2531
Country	:	US
Telephone Number	:	817-763-5900
Fax Number	:	817-763-5858

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. ROCKY LEE VIG
Credential	:
Telephone Number	:	214-437-2309

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	07/21/2022

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Directions to “RAMIC FORT WORTH, LLC ” Practice Location

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