Provider Demographics
NPI:1003237215
Name:LEGACY HEART CARE OF KANSAS CITY, LLC
Entity Type:Organization
Organization Name:LEGACY HEART CARE OF KANSAS CITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
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:STE 200
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5848
Mailing Address - Country:US
Mailing Address - Phone:817-423-4400
Mailing Address - Fax:817-423-8080
Practice Address - Street 1:4550 W 109TH ST
Practice Address - Street 2:STE 230
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1360
Practice Address - Country:US
Practice Address - Phone:817-423-4400
Practice Address - Fax:817-423-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty