Healthcare Provider Details

I. General information

NPI: 1376395533
Provider Name (Legal Business Name): ROBERT C HEED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5162 GLENMOORE WAY
MEDINA OH
44256-6838
US

IV. Provider business mailing address

5162 GLENMOORE WAY
MEDINA OH
44256-6838
US

V. Phone/Fax

Practice location:
  • Phone: 330-421-8050
  • Fax: 330-725-4061
Mailing address:
  • Phone: 330-421-8050
  • Fax: 330-725-4061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: