Organization
PROVIDENCE HEALTH & SERVICES MT
Active
Parent organization
PROVIDENCE HEALTH & SERVICES
Other names
PMG MT IHI, PROVIDENCE MEDICAL GOUP MONTANA
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES
Authorized official
DONALD WAYNE ANDERSON JR. (ASST SECRETARY ENROLLMENT)
(425) 358-9786
Entity
Organization
Contact information
Practice address
500 W BROADWAY ST, SUITE 320, MISSOULA, MT 59802
(406) 329-5615
(406) 329-5606
Mailing address
PO BOX 31001 - 4114, PASADENA, CA 91110-4114
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
N/A
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
N/A
—
207RI0011X
Interventional Cardiology Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
363AM0700X
Medical Physician Assistant
N/A
—
Other
Enumeration date
06/02/2006
Last updated
05/06/2025
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