Healthcare Provider Details

I. General information

NPI: 1255852232
Provider Name (Legal Business Name): MONTANA WOMEN'S HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 FORT MISSOULA RD SUITE 202
MISSOULA MT
59804-7423
US

IV. Provider business mailing address

2835 FORT MISSOULA RD SUITE 202
MISSOULA MT
59804-7423
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-4292
  • Fax: 406-728-5770
Mailing address:
  • Phone: 406-728-4292
  • Fax: 406-728-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT CHRISTOPHER WYMAN
Title or Position: REGISTERED AGENT
Credential: M.D.
Phone: 406-728-4292