45D2072255 CLIA NUMBER - MIDTOWN MEDICAL IMAGING

Laboratory Demographics

  • CLIA Code: 45D2072255
  • Facility Name: MIDTOWN MEDICAL IMAGING
  • Facility Address: 900 JEROME ST, STE 104
    FORT WORTH, TX
    ZIP 76104
  • Facility Phone: 817 768-5317
  • Facility Type: Other - RADIOLOGY IMAGING CTR
  • Facility Type: Waiver
  • Lab Director: BRADLEY MICHAEL SCOBLE
  • NPI Number: 1972937027
  • Taxonomy: 261QM1200X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 45D2072255
LAB Type Other - RADIOLOGY IMAGING CTR
Facility Name MIDTOWN MEDICAL IMAGING
Street 900 JEROME ST, STE 104
City FORT WORTH
State TX
ZIP 76104
Phone 817 768-5317
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/28/2024
Certificate Expiration Date 1/27/2026
Facility Type Other - RADIOLOGY IMAGING CTR
Lab Director BRADLEY MICHAEL SCOBLE

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This page was last updated on: 9/29/2025