Independent Mobil Diagnostice Testing Facility

NPI #1437434206 in Cleburne, Texas

Provider Information

NPI Number: 1437434206
Entity Type: Organization
Organization Name: Independent Mobil Diagnostice Testing Facility
Primary Specialty: Preferred Provider Organization
Enumeration Date: Oct 12, 2011
Last Updated: Oct 12, 2011

Practice Location

Address: 1661 WOODARD AVE
Address 2: SUITE 110
City: Cleburne
State: Texas
ZIP Code: 76033-7052
Phone: (817) 494-6875

Authorized Official

Name: MR. EDMOND S MAXON, LBSW
Title: ED
Phone: (817) 494-6875

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X
Preferred Provider Organization	305R00000X	Primary

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