Provider Demographics
NPI:1144520503
Name:LEGACY HEARTCARE OF DALLAS, LLC
Entity type:Organization
Organization Name:LEGACY HEARTCARE OF DALLAS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-423-4400
Mailing Address - Street 1:2500 WEST FWY
Mailing Address - Street 2:200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4716 DEXTER DR STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5288
Practice Address - Country:US
Practice Address - Phone:972-490-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEGACY HEARTCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-01
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty