Provider Demographics
NPI:1376395533
Name:HEED, ROBERT C
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:HEED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5162 GLENMOORE WAY
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-6838
Mailing Address - Country:US
Mailing Address - Phone:330-421-8050
Mailing Address - Fax:330-725-4061
Practice Address - Street 1:5162 GLENMOORE WAY
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-6838
Practice Address - Country:US
Practice Address - Phone:330-421-8050
Practice Address - Fax:330-725-4061
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver