Provider Demographics
NPI:1871788224
Name:RAMIC FORT WORTH, LLC
Entity type:Organization
Organization Name:RAMIC FORT WORTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROCKY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-437-2309
Mailing Address - Street 1:750 12TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2531
Mailing Address - Country:US
Mailing Address - Phone:817-763-5900
Mailing Address - Fax:817-763-5858
Practice Address - Street 1:750 12TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2531
Practice Address - Country:US
Practice Address - Phone:817-763-5900
Practice Address - Fax:817-763-5858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEG, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195662501Medicaid
TXFTX230Medicare PIN
TX195662501Medicaid