Healthcare Provider Details

I. General information

NPI: 1770303281
Provider Name (Legal Business Name): SCOTT JEFFREY MINER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S SANSOME ST
PHILIPSBURG MT
59858-7711
US

IV. Provider business mailing address

1028 N WARREN ST
HELENA MT
59601-3453
US

V. Phone/Fax

Practice location:
  • Phone: 406-859-3271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: