Organization
PROVIDENCE HEALTH & SERVICES MT
Active
Other names
Providence Medical Group MT - MDPP
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
900 N ORANGE ST STE 304, MISSOULA, MT 59802-2951
(406) 329-5781
(406) 327-3331
Mailing address
PO BOX 31001 - 4114, PASADENA, CA 91110-4114
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
04/06/2018
Last updated
05/07/2025
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