Provider Demographics
NPI:1629527312
Name:MIDTOWN MEDICAL IMAGING - ALLIANCE
Entity Type:Organization
Organization Name:MIDTOWN MEDICAL IMAGING - ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-768-5317
Mailing Address - Street 1:900 JEROME ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9557 N. BEACH ST.
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244
Practice Address - Country:US
Practice Address - Phone:817-768-5317
Practice Address - Fax:817-920-9992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)