MEDICARE: SCOTT DEAN HEIM

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	2112454	AK

General Provider Information

NPI Number	:	1427661974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT DEAN HEIM

Provider Business Mailing Address
First Line	:	PO BOX 922
Second Line	:
City	:	PALMER
State	:	AK
Zip	:	99645-0922
Country	:	US
Telephone Number	:	907-982-9226
Fax Number	:	907-746-7035

Provider Business Practice Location Address
First Line	:	1051 E BOGARD RD STE 6
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7174
Country	:	US
Telephone Number	:	907-982-9226
Fax Number	:	907-746-7035

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

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	08/25/2020

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Directions to “ SCOTT DEAN HEIM ” Practice Location

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