Provider Demographics
NPI:1174252837
Name:LEGACY HEART CARE OF GRAND PRAIRIE
Entity Type:Organization
Organization Name:LEGACY HEART CARE OF GRAND PRAIRIE
Other - Org Name:FLOW THERAPY GRAND PRAIRIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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 1:4927 LAKE RIDGE PKWY STE 145
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3087
Mailing Address - Country:US
Mailing Address - Phone:817-423-4400
Mailing Address - Fax:
Practice Address - Street 1:4927 LAKE RIDGE PKWY STE 145
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3087
Practice Address - Country:US
Practice Address - Phone:817-423-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty