# MIDTOWN MEDICAL IMAGING - SOUTHLAKE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023683307
- **Authorized official:** MR. BRAD MICHAEL SCOBLE (OWNER)
- **Authorized official phone:** (817) 898-8800

## Contact information

- **Practice address:** 731 E SOUTHLAKE BLVD STE 105, SOUTHLAKE, TX 76092-6377
- **Practice address phone:** (817) 898-8800
- **Mailing address:** 731 E SOUTHLAKE BLVD STE 105, SOUTHLAKE, TX 76092-6377
- **Mailing address phone:** (817) 898-8800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1200X | Magnetic Resonance Imaging (MRI) Clinic/Center | — | — | — |
| 261QR0200X | Radiology Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 05/20/2021
- **Last updated:** 05/20/2021