# 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 Women's Care Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1417198243
- **Legal business name:** PROVIDENCE HEALTH & SERVICES
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 1211 S RESERVE ST STE 101, MISSOULA, MT 59801-3103
- **Practice address phone:** (406) 327-3057
- **Practice address fax:** (406) 327-3231
- **Mailing address:** PO BOX 31001-4114, PASADENA, CA 91110-4114
- **Mailing address phone:** (406) 327-1918
- **Mailing address fax:** (406) 329-2937

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

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