MEDICARE: PROVIDENCE HEALTH & SERVICES MT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician

General Provider Information

NPI Number	:	1336380161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HEALTH & SERVICES MT

Provider Business Mailing Address
First Line	:	PO BOX 31001 - 4114
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91110-4114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 N ORANGE ST
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-2928
Country	:	US
Telephone Number	:	406-321-1732
Fax Number	:	425-687-3615

Authorized Official
Title or Position	:	ASSISTANT SECRETARY ENROLLMENTS
Name	:	DONALD WAYNE ANDERSON JR.
Credential	:
Telephone Number	:	425-358-9786

Provider Enumeration Date	:	03/06/2009
Last Update Date	:	05/06/2025

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Practice Location Address:

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1003821976 — MR. BROOKS WILLIAM BAER LCPC
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902 N ORANGE ST , SUITE 102
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1144319138 — PROVIDENCE HEALTH & SERVICES MT
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1619058302 — PROVIDENCE HEALTH & SERVICES MT
Practice Location Address:

902 N ORANGE ST
MISSOULA, MT
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1093830515 — ROBERT C. MUNJAL MD
Practice Location Address:

902 N ORANGE ST , SUITE 206
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1376704924 — MRS. FRANCESCA F AYTES LCSW
Practice Location Address:

902 N ORANGE ST STE 102
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Directions to “PROVIDENCE HEALTH & SERVICES MT ” Practice Location

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