MEDICARE: MR. NATHAN R HEATH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	347C00000X	Private Vehicle
3	172A00000X	Driver

General Provider Information

NPI Number	:	1720653090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NATHAN R HEATH

Provider Business Mailing Address
First Line	:	769 SUNSET BLVD APT 8
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2660
Country	:	US
Telephone Number	:	419-631-3687
Fax Number	:

Provider Business Practice Location Address
First Line	:	769 SUNSET BLVD APT 8
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2660
Country	:	US
Telephone Number	:	419-631-3687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2021
Last Update Date	:	05/20/2021

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Directions to “ MR. NATHAN R HEATH ” Practice Location

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