Organization
PROVIDENCE HEALTH & SERVICES MT
Active
Other names
Providence Medical Group Montana Neurosurgical Specialists, PROVIDENCE MEDICAL GROUP MONTANA
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
500 W BROADWAY ST, MISSOULA, MT 59802-4008
(406) 327-1918
Mailing address
PO BOX 31001 - 4114, PASADENA, CA 91110-4114
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
9574
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M000009936
MEDICARE GROUP PTAN
MT
Enumeration date
01/12/2015
Last updated
05/07/2025
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