# PROVIDENCE HEALTH & SERVICES MT

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE HEALTH & SERVICES
- **Other names:** PROVIDENCE MEDICAL GROUP MONTANA, Providence Primary Care Stevensville, PMG MT Lifespan Family Med
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1558407312
- **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:** 715 MAIN ST, SUITE A, STEVENSVILLE, MT 59870-2861
- **Practice address phone:** (406) 777-5522
- **Practice address fax:** (406) 777-1175
- **Mailing address:** PO BOX 31001 - 4114, PASADENA, CA 91110-4114
- **Mailing address phone:** (406) 777-5522
- **Mailing address fax:** (406) 777-1175

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | NA | — | Yes |

## Other

- **Enumeration date:** 01/29/2007
- **Last updated:** 09/17/2026