Organization
PROVIDENCE HEALTH & SERVICES MT
Active
Parent organization
PROVIDENCE HEALTH & SERVICES
Other names
PROVIDENCE MEDICAL GROUP MONTANA, PMG MT Trauma Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
500 W BROADWAY ST, MISSOULA, MT 59802-4008
(406) 327-1918
Mailing address
PO BOX 12, LIBERTY LAKE, WA 99019-0012
(406) 327-1918
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
—
—
Other
Enumeration date
03/05/2009
Last updated
05/05/2025
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