# PROVIDENCE HEALTH & SERVICES MT

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE HEALTH & SERVICES
- **Other names:** PMG MT Spine & Pain, PROVIDENCE MEDICAL GROUP MONTANA
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1063653897
- **Legal business name:** PROVIDENCE HEALTH & SERVICES
- **Authorized official:** DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 500 W BROADWAY ST, 3RD FLOOR, MISSOULA, MT 59802-4096
- **Practice address phone:** (406) 327-1670
- **Mailing address:** PO BOX 31001 - 4114, PASADENA, CA 91110-4114
- **Mailing address phone:** (406) 327-1918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P0004X | Spinal Cord Injury Medicine Physician | — | NULL | Yes |
| 2081P0004X | Spinal Cord Injury Medicine Physician | — | — | Yes |
| 261QP3300X | Pain Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/06/2009
- **Last updated:** 05/06/2025