# PROVIDENCE HEALTH & SERVICES MT

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Providence Medical Group Montana
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083578314
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 3017 PAXSON STREET, MISSOULA, MT 59801
- **Practice address phone:** (406) 519-3422
- **Mailing address:** PO BOX 31001 - 4114, PASADENA, CA 91110-4114

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/11/2025
- **Last updated:** 12/11/2025