Provider Demographics
NPI:1427661974
Name:HEIM, SCOTT DEAN
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DEAN
Last Name:HEIM
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:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-0922
Mailing Address - Country:US
Mailing Address - Phone:907-982-9226
Mailing Address - Fax:907-746-7035
Practice Address - Street 1:1051 E BOGARD RD STE 6
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7174
Practice Address - Country:US
Practice Address - Phone:907-982-9226
Practice Address - Fax:907-746-7035
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2112454332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies