# PROVIDENCE HEALTH & SERVICES MT

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PROVIDENCE MEDICAL GROUP MONTANA, PMG MT Pediatrics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730802364
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 900 N ORANGE ST STE 303, MISSOULA, MT 59802-2956
- **Practice address phone:** (406) 327-7337
- **Practice address fax:** (406) 327-7373
- **Mailing address:** PO BOX 31001 - 4114, PASADENA, CA 91110-4114

## Taxonomy

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

## Other

- **Enumeration date:** 09/20/2022
- **Last updated:** 05/07/2025