Organization
PROVIDENCE HEALTH & SERVICES MT
Active
Parent organization
PROVIDENCE HEALTH & SERVICES
Other names
PROVIDENCE MEDICAL GROUP MONTANA, SPH ER Physicians
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
500 W. BROADWAY, MISSOULA, MT 59802-4008
(406) 543-7271
(406) 329-2937
Mailing address
PO BOX 31001 - 4114 PROVIDENCE HEALTH & SERVICES MT, PASADENA, CA 91110-4114
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
10606
MT
Other
Enumeration date
08/16/2006
Last updated
05/07/2025
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