Organization · NPI-2

Grateful Heart Medical Services PLLC

Internal Medicine · Dallas, TX

NPI number1336714708

StatusActive

Last updated in NPPESMay 26, 2021

Details

NPI: 1336714708
Entity type: Organization (NPI-2)
Legal business name: Grateful Heart Medical Services PLLC
Organization subpart: No
Enumeration date: May 26, 2021
Certification date: May 26, 2021
Last updated: May 26, 2021

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207R00000X	Internal Medicine	–	–	Yes
251E00000X	Home Health	–	–
251F00000X	Home Infusion	–	–
251J00000X	Nursing Care	–	–
251K00000X	Public Health or Welfare	–	–
251V00000X	Voluntary or Charitable	–	–
252Y00000X	Early Intervention Provider Agency	–	–
261QC1500X	Clinic/Center, Community Health	–	–
261QH0100X	Clinic/Center, Health Services	–	–
261QP2300X	Clinic/Center, Primary Care	–	–
261QR0800X	Clinic/Center, Recovery Care	–	–
261QR1300X	Clinic/Center, Rural Health	–	–
302R00000X	Health Maintenance Organization	–	–
343900000X	Non-emergency Medical Transport (VAN)	–	–

Practice location

4210 Fairmount St
Dallas, TX 75219-3335

Phone 469-363-1058

Mailing address

6717 Windward View Dr
Rowlett, TX 75088-2226

Phone 469-363-1058

Authorized official

Adetomiwa I Ogundere
Ceo
4693631058

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