Provider Demographics
NPI:1558307371
Name:SCOTT, JOHN GREGORY (PAC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GREGORY
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 15TH AVE S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4324
Mailing Address - Country:US
Mailing Address - Phone:406-455-3650
Mailing Address - Fax:406-455-3695
Practice Address - Street 1:500 15TH AVE S
Practice Address - Street 2:SUITE 1
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4324
Practice Address - Country:US
Practice Address - Phone:406-455-3650
Practice Address - Fax:406-455-3695
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT304363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT810347861OtherCHAMPUS
MT0221549OtherWASHINGTON L & I
MT000097253OtherBLUE CROSS BLUE SHIELD
MT0025090Medicaid
MT0232060001Medicare PIN