Organization
PROVIDENCE HEALTH & SERVICES MT
Active
Parent organization
PROVIDENCE HEALTH & SERVICES
Other names
PMG MT Montana Internal Med
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HEALTH & SERVICES
Authorized official
MR. KIRK BODLOVIC (CFO)
(406) 327-1918
Entity
Organization
Contact information
Practice address
2819 GREAT NORTHERN LOOP, SUITE 200, MISSOULA, MT 59808-1750
(406) 543-1197
(406) 543-0515
Mailing address
PO BOX 12, LIBERTY LAKE, WA 99019-0012
(406) 327-1918
(406) 329-2937
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0411866
MT
Other
Enumeration date
12/30/2008
Last updated
11/22/2013
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