NPI Code Detail JSON Logo

1366185928 NPI number — PROVIDENCE HEALTH & SERVICES MT

NPI Number: 1366185928
Health Care Provider/Practitioner: PROVIDENCE HEALTH & SERVICES MT

Information about “1366185928” NPI (PROVIDENCE HEALTH & SERVICES MT) exists in 1366185928 in HTML format HTML  |  1366185928 in plain Text format TXT  |  1366185928 in PDF (Portable Document Format) PDF  |  1366185928 in an XML format XML  formats.

NPI Number : 1366185928 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1366185928",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PROVIDENCE HEALTH & SERVICES MT",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 31001-4110",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PASADENA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91110-4110",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "406-329-5838",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "500 W BROADWAY ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MISSOULA",
    "PracticeLocationAddressStateName": "MT",
    "PracticeLocationAddressPostalCode": "59802-4008",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "406-329-5838",
    "PracticeLocationAddressFaxNumber": "406-329-5676",
    "EnumerationDate": "04/20/2022",
    "LastUpdateDate": "09/02/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ANDERSON",
    "AuthorizedOfficialFirstName": "DONALD",
    "AuthorizedOfficialMiddleName": "WAYNE",
    "AuthorizedOfficialTitle": "ASSISTANT SECRETARY FOR ENROLLMENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": "JR.",
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "425-358-9786",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207ZP0105X",
          "TaxonomyName": "Clinical Pathology/Laboratory Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "282N00000X",
          "TaxonomyName": "General Acute Care Hospital",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207ZP0102X",
          "TaxonomyName": "Anatomic Pathology & Clinical Pathology Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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