Basic Information
| Provider Information | |||||||||
| NPI: | 1255448783 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OWENS | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 FRUIT RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | MOSCOW | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451539738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138760610 | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 N. UNION STREET | ||||||||
| Address2: | |||||||||
| City: | BETHEL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451061313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137349050 | ||||||||
| FaxNumber: | 5137349051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.083151 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2437723 | 05 | OH | MEDICAID |