Organization
GRATEFUL HEART MEDICAL SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADETOMIWA I OGUNDERE MD (CEO)
(469) 363-1058
Entity
Organization
Contact information
Practice address
4210 FAIRMOUNT ST, DALLAS, TX 75219-3335
(469) 363-1058
Mailing address
6717 WINDWARD VIEW DR, ROWLETT, TX 75088-2226
(469) 363-1058
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
251E00000X
Home Health Agency
—
—
251F00000X
Home Infusion Agency
—
—
251J00000X
Nursing Care Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251V00000X
Voluntary or Charitable Agency
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
261QR0800X
Recovery Care Clinic/Center
—
—
261QR1300X
Rural Health Clinic/Center
—
—
302R00000X
Health Maintenance Organization
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
05/26/2021
Last updated
05/26/2021
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