Organization
PROVIDENCE HEALTH & SERVICES MT
Active
Parent organization
PROVIDENCE HEALTH & SERVICES
Other names
PMG MT IHI Deer Lodge
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
1101 TEXAS AVE, DEER LODGE, MT 59722-1828
(406) 846-1722
(406) 329-5606
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-4114
(406) 329-5615
(406) 329-5606
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
Other
Enumeration date
05/20/2008
Last updated
06/20/2025
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