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General NPI Number Information
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NPI Number | 1326483587
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HEALTH & SERVICES MT
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 500 W BROADWAY ST
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City | MISSOULA
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State | MT
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Zip | 59802-4008
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Country | US
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Telephone | 406-728-2539
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 31001-4110
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City | PASADENA
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State | CA
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Zip | 91110-4110
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ASSISTANT SECRETARY OF ENROLLMENTS
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Name | DONALD W ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 13200
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License Number State | MT
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