Provider Demographics
NPI:1275215808
Name:LEGACY HEARTCARE OF DALLAS, LLC
Entity Type:Organization
Organization Name:LEGACY HEARTCARE OF DALLAS, LLC
Other - Org Name:FLOW THERAPY MCKINNEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCISM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-957-1322
Mailing Address - Street 1:7300 ELDORADO PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-7891
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7300 ELDORADO PKWY STE 105
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-7891
Practice Address - Country:US
Practice Address - Phone:972-490-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty