Healthcare Provider Details

I. General information

NPI: 1548394836
Provider Name (Legal Business Name): PROVIDENCE ST JOSEPH MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 13TH AVE E
POLSON MT
59860-5315
US

IV. Provider business mailing address

PO BOX 1010
POLSON MT
59860-1010
US

V. Phone/Fax

Practice location:
  • Phone: 406-883-5377
  • Fax:
Mailing address:
  • Phone: 406-883-5377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRUCE WHITFIELD
Title or Position: CFO WESTERN MONTANA REGION
Credential:
Phone: 406-329-5868