Provider Demographics
NPI:1255852232
Name:MONTANA WOMEN'S HEALTHCARE, LLC
Entity Type:Organization
Organization Name:MONTANA WOMEN'S HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:WYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-728-4292
Mailing Address - Street 1:2835 FORT MISSOULA RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7423
Mailing Address - Country:US
Mailing Address - Phone:406-728-4292
Mailing Address - Fax:406-728-5770
Practice Address - Street 1:2835 FORT MISSOULA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7423
Practice Address - Country:US
Practice Address - Phone:406-728-4292
Practice Address - Fax:406-728-5770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty