Healthcare Provider Details

I. General information

NPI: 1346869096
Provider Name (Legal Business Name): SETH HEYING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W LOSEY ST
SCOTT AFB IL
62225-5250
US

IV. Provider business mailing address

310 W LOSEY ST
SCOTT AFB IL
62225-5250
US

V. Phone/Fax

Practice location:
  • Phone: 618-256-5203
  • Fax:
Mailing address:
  • Phone: 618-256-5203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: