Organization
PROVIDENCE HEALTH & SERVICES MT
Active
Other names
St Patrick Hospital Pathology
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY FOR ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
500 W BROADWAY ST, MISSOULA, MT 59802-4008
(406) 329-5838
(406) 329-5676
Mailing address
PO BOX 31001-4110, PASADENA, CA 91110-4110
(406) 329-5838
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
—
—
282N00000X
General Acute Care Hospital
—
—
Other
Enumeration date
04/20/2022
Last updated
09/02/2025
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