# PROVIDENCE ST JOSEPH MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Prov St Joseph Med Ctr
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669655528
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTNAT SECRETARY ENROLLMENT)
- **Authorized official phone:** (425) 359-9786

## Contact information

- **Practice address:** 6 13TH AVE E, POLSON, MT 59860-5315
- **Practice address phone:** (406) 883-5377
- **Mailing address:** PO BOX 31001-4110, PASADENA, CA 91110-4110
- **Mailing address phone:** (406) 883-5377

## Taxonomy

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

## Other

- **Enumeration date:** 12/13/2007
- **Last updated:** 04/05/2025