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
1	207RI0011X	Interventional Cardiology Physician
2	207RP1001X	Pulmonary Disease Physician
3	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1871750646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HEALTH & SERVICES MT

Provider Business Mailing Address
First Line	:	PO BOX 34439
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1439
Country	:	US
Telephone Number	:	406-329-5615
Fax Number	:	406-329-5606

Provider Business Practice Location Address
First Line	:	301 SADDLE DR
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-8026
Country	:	US
Telephone Number	:	406-442-8777
Fax Number	:	406-442-8999

Authorized Official
Title or Position	:	RCM OPERATIONS MANAGER
Name	:	MRS. TERI MASTERS
Credential	:
Telephone Number	:	406-329-5795

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	06/22/2011

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Directions to “PROVIDENCE HEALTH & SERVICES MT ” Practice Location

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