Healthcare Provider Details

I. General information

NPI: 1558307371
Provider Name (Legal Business Name): JOHN GREGORY SCOTT P.A.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 15TH AVE S SUITE 1
GREAT FALLS MT
59405-4324
US

IV. Provider business mailing address

500 15TH AVE S SUITE 1
GREAT FALLS MT
59405-4324
US

V. Phone/Fax

Practice location:
  • Phone: 406-455-3650
  • Fax: 406-455-3695
Mailing address:
  • Phone: 406-455-3650
  • Fax: 406-455-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number304
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: