# PROVIDENCE HEALTH & SERVICES MT

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

## Provider details

- **NPI number:** 1215222617
- **Legal business name:** PROVIDENCE HEALTH & SERVICES
- **Authorized official:** DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 500 W BROADWAY ST, MISSOULA, MT 59802-4008
- **Practice address phone:** (406) 543-7271
- **Mailing address:** PO BOX 31001 - 4114, PASADENA, CA 91110-4114

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RB0002X | Obesity Medicine (Internal Medicine) Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | — |
| 207RH0002X | Hospice and Palliative Medicine (Internal Medicine) Physician | — | — | — |
| 207RI0200X | Infectious Disease Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 2081P0004X | Spinal Cord Injury Medicine Physician | — | — | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |
| 314000000X | Skilled Nursing Facility | — | — | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 06/14/2011
- **Last updated:** 05/06/2025