Healthcare Provider Details

I. General information

NPI: 1730186057
Provider Name (Legal Business Name): BELINDA A HEYWOOD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 E WOOSTER ST
BOWLING GREEN OH
43402-3186
US

IV. Provider business mailing address

745 HASKINS RD SUITE B
BOWLING GREEN OH
43402-1600
US

V. Phone/Fax

Practice location:
  • Phone: 419-372-2271
  • Fax: 419-372-8010
Mailing address:
  • Phone: 419-353-7069
  • Fax: 419-353-7076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50001922
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.001922RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: