Provider Demographics
NPI:1366824930
Name:SCOTT C WYMAN MD PC
Entity Type:Organization
Organization Name:SCOTT C WYMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHAPLA
Authorized Official - Suffix:
Authorized Official - Credentials:
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:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18612207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407172612OtherINDIVIDUAL NPI