# PROVIDENCE HEALTH & SERVICES MT

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

## Provider details

- **NPI number:** 1235370065
- **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 STE 210, MISSOULA, MT 59802-4008
- **Practice address phone:** (406) 329-5736
- **Mailing address:** PO BOX 31001 - 4114, PASADENA, CA 91110-4114
- **Mailing address phone:** (406) 327-5734

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WW0000X | Wound Care Registered Nurse | — | — | — |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/06/2009
- **Last updated:** 09/16/2026