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General NPI Number Information
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NPI Number | 1669655528
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Entity Type | Organization
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Legal Business Name | PROVIDENCE ST JOSEPH MEDICAL CENTER
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 04/05/2025
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Provider Practice Location Address
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Address Line | 6 13TH AVE E
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City | POLSON
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State | MT
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Zip | 59860-5315
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Country | US
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Telephone | 406-883-5377
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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 | 406-883-5377
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Fax |
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Authorized Official
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Title or Position | ASSISTNAT SECRETARY ENROLLMENT
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Name | DONALD WAYNE ANDERSON JR.
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Credential |
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Telephone | 425-359-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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