Organization
PROVIDENCE SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY LONGGOOD RN (ADMINISTRATOR)
(406) 327-3300
Entity
Organization
Contact information
Practice address
902 N ORANGE ST, MISSOULA, MT 59802-2916
(406) 327-3300
(406) 327-3302
Mailing address
902 N ORANGE ST, MISSOULA, MT 59802-2916
(406) 327-3300
(406) 327-3302
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
10708
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0350098
—
MT
Enumeration date
07/29/2006
Last updated
12/31/2024
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