Healthcare Provider Details

I. General information

NPI: 1346768892
Provider Name (Legal Business Name): LEGACY HEART CARE OF SOUTH AUSTIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 SETON PKWY STE 280
KYLE TX
78640-6178
US

IV. Provider business mailing address

2500 WEST FWY STE 200
FORT WORTH TX
76102-5851
US

V. Phone/Fax

Practice location:
  • Phone: 512-297-2100
  • Fax: 512-419-1099
Mailing address:
  • Phone: 817-423-4400
  • Fax: 817-423-8080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL B GRATCH
Title or Position: PRESIDENT
Credential:
Phone: 817-423-4400