Provider Demographics
NPI:1295063949
Name:GRAPEVINE CARDIOLOGY
Entity type:Organization
Organization Name:GRAPEVINE CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-424-3278
Mailing Address - Street 1:1643 LANCASTER DR
Mailing Address - Street 2:STE. 203
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3593
Mailing Address - Country:US
Mailing Address - Phone:817-424-3278
Mailing Address - Fax:817-416-0145
Practice Address - Street 1:1643 LANCASTER DR
Practice Address - Street 2:STE. 203
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3593
Practice Address - Country:US
Practice Address - Phone:817-424-3278
Practice Address - Fax:817-416-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty