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General NPI Number Information
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NPI Number | 1467810663
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Entity Type | Organization
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Legal Business Name | LEGACY HEART CARE OF CHARLOTTE, LLC
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 6701 CARMEL RD UNIT 355
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City | CHARLOTTE
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State | NC
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Zip | 28226-4147
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Country | US
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Telephone | 704-334-1401
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Fax | 817-423-8080
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Provider Business Mailing Address
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Address Line | 2500 WEST FWY STE 200
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City | FORT WORTH
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State | TX
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Zip | 76102-5851
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Country | US
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Telephone | 704-334-1401
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Fax | 704-334-1471
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL GRATCH
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Credential |
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Telephone | 817-423-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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