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General NPI Number Information
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NPI Number | 1255852232
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Entity Type | Organization
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Legal Business Name | MONTANA WOMEN'S HEALTHCARE, LLC
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Dates
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Enumeration Date | 06/29/2017
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Last Update Date | 06/29/2017
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Provider Practice Location Address
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Address Line | 2835 FORT MISSOULA RD SUITE 202
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City | MISSOULA
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State | MT
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Zip | 59804-7423
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Country | US
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Telephone | 406-728-4292
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Fax | 406-728-5770
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Provider Business Mailing Address
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Address Line | 2835 FORT MISSOULA RD SUITE 202
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City | MISSOULA
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State | MT
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Zip | 59804-7423
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Country | US
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Telephone | 406-728-4292
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Fax | 406-728-5770
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | MR. SCOTT CHRISTOPHER WYMAN
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Credential | M.D.
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Telephone | 406-728-4292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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