Organization
PROVIDENCE HEALTH & SERVICES MT
Active
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up