Provider Demographics
NPI:1336714708
Name:GRATEFUL HEART MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:GRATEFUL HEART MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADETOMIWA
Authorized Official - Middle Name:I
Authorized Official - Last Name:OGUNDERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-363-1058
Mailing Address - Street 1:6717 WINDWARD VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-2226
Mailing Address - Country:US
Mailing Address - Phone:469-363-1058
Mailing Address - Fax:
Practice Address - Street 1:4210 FAIRMOUNT ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-3335
Practice Address - Country:US
Practice Address - Phone:469-363-1058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty