Provider Demographics
NPI:1093039828
Name:HEATH, AMY H (IDMT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:H
Last Name:HEATH
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4422 LA HABRA WAY
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-7768
Mailing Address - Country:US
Mailing Address - Phone:503-989-2694
Mailing Address - Fax:
Practice Address - Street 1:211 ARNOLD AVE
Practice Address - Street 2:STE 15
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-2111
Practice Address - Country:US
Practice Address - Phone:503-989-2694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians