# PROVIDENCE HEALTH & SERVICES MT

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

## Provider details

- **NPI number:** 1124268966
- **Legal business name:** PROVIDENCE HEALTH & SERVICES
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 500 W BROADWAY ST, MISSOULA, MT 59802-4008
- **Practice address phone:** (406) 327-1918
- **Mailing address:** PO BOX 12, LIBERTY LAKE, WA 99019-0012
- **Mailing address phone:** (406) 327-1918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | NULL | Yes |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | — | Yes |

## Other

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