NPIMap

Organization Active NPI

Midtown Medical Imaging - Southlake, LLC

  • Radiology Clinic/Center
  • Southlake, TX
National Provider Identifier
1023683307
Registry record updated May 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
MIDTOWN MEDICAL IMAGING - SOUTHLAKE, LLC
Practice address
731 E Southlake Blvd Ste 105
Southlake, TX 76092-6377
Phone
(817) 898-8800
NPI assigned
May 20, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Brad Michael Scoble
Title
Owner
Phone
(817) 898-8800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

731 E Southlake Blvd Ste 105
Southlake, TX 76092-6377

Mailing address

731 E Southlake Blvd Ste 105
Southlake, TX 76092-6377
Phone (817) 898-8800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221107003082 TX Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 5193192920 Practice locations: Southlake, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2228921Midtown Medical Imaging-Southlake, LLC731 E Southlake Blvd, Ste 105, Southlake, TX 76092Certificate of waiverJul 1, 2027

National Provider Directory

National Provider Directory

Locations

731 E Southlake Blvd
Ste 105
Southlake, TX 76092
Phone (817) 768-5317

Practitioners & affiliated clinicians

Practitioners 44

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 44

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621468800000",
    "number": "1023683307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 E SOUTHLAKE BLVD STE 105",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926377",
            "telephone_number": "817-898-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 E SOUTHLAKE BLVD STE 105",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926377",
            "telephone_number": "817-898-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDTOWN MEDICAL IMAGING - SOUTHLAKE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-20",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A",
        "authorized_official_last_name": "SCOBLE",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-898-8800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.