Organization
PROVIDENCE HEALTH & SERVICES MT
Active
Parent organization
PROVIDENCE HEALTH & SERVICES
Other names
PROVIDENCE MEDICAL GROUP MONTANA, PMG MT Lifespan Family Med
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
715 MAIN ST, SUITE A, STEVENSVILLE, MT 59870-2861
(406) 777-5522
(406) 777-1175
Mailing address
PO BOX 31001 - 4114, PASADENA, CA 91110-4114
(406) 777-5522
(406) 777-1175
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
NA
—
Other
Enumeration date
01/29/2007
Last updated
05/07/2025
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