Provider Demographics
NPI:1053882530
Name:HERITAGE RHEUMATOLOGY & ARTHRITIS CARE
Entity type:Organization
Organization Name:HERITAGE RHEUMATOLOGY & ARTHRITIS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DHIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-590-0880
Mailing Address - Street 1:5009 HERITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-5913
Mailing Address - Country:US
Mailing Address - Phone:817-590-0880
Mailing Address - Fax:817-590-0199
Practice Address - Street 1:5009 HERITAGE AVE
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5913
Practice Address - Country:US
Practice Address - Phone:817-590-0880
Practice Address - Fax:817-590-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty