# PROVIDENCE HEALTH & SERVICES MT

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St Patrick Hospital Pathology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366185928
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY FOR ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 500 W BROADWAY ST, MISSOULA, MT 59802-4008
- **Practice address phone:** (406) 329-5838
- **Practice address fax:** (406) 329-5676
- **Mailing address:** PO BOX 31001-4110, PASADENA, CA 91110-4110
- **Mailing address phone:** (406) 329-5838

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | NULL | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | — | Yes |
| 207ZP0105X | Clinical Pathology/Laboratory Medicine Physician | — | NULL | — |
| 207ZP0105X | Clinical Pathology/Laboratory Medicine Physician | — | — | — |
| 282N00000X | General Acute Care Hospital | — | NULL | — |

## Other

- **Enumeration date:** 04/20/2022
- **Last updated:** 09/02/2025