Basic Information
| Provider Information | |||||||||
| NPI: | 1255852232 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTANA WOMEN'S HEALTHCARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2835 FORT MISSOULA RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598047423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067284292 | ||||||||
| FaxNumber: | 4067285770 | ||||||||
| Practice Location | |||||||||
| Address1: | 2835 FORT MISSOULA RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598047423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067284292 | ||||||||
| FaxNumber: | 4067285770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2017 | ||||||||
| LastUpdateDate: | 06/29/2017 | ||||||||
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| AuthorizedOfficialLastName: | WYMAN | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
| AuthorizedOfficialMiddleName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialTitleorPosition: | REGISTERED AGENT | ||||||||
| AuthorizedOfficialTelephone: | 4067284292 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.