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	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1083578314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HEALTH & SERVICES MT

Provider Business Mailing Address
First Line	:	PO BOX 31001 - 4114
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91110-4114
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3017 PAXSON STREET
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801
Country	:	US
Telephone Number	:	406-519-3422
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT SECRETARY ENROLLMENT
Name	:	DONALD WAYNE ANDERSON JR.
Credential	:
Telephone Number	:	425-358-9786

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

Similar Medicare Providers

1942157276 — POMALO PLLC
Practice Location Address:

401 S ORANGE ST
MISSOULA, MT
59801-2525

Practice Phone: 406-213-5166
Practice Fax:

1528096146 — JOEY MICHELE BANKS MD
Practice Location Address:

121 HICKORY ST STE 4
MISSOULA, MT
59801-1896

Practice Phone: 406-541-2012
Practice Fax: 406-296-4320

1760330773 — JULIANNE POULIN
Practice Location Address:

1561 S 12TH ST W APT B
MISSOULA, MT
59801-4856

Practice Phone: 508-505-6533
Practice Fax:

1134411671 — SOUTHERN HOME CARE SERVICES, INC.
Practice Location Address:

3309 BROOKS ST STE B
MISSOULA, MT
59801-8249

Practice Phone: 406-251-9333
Practice Fax:

1598616310 — JILL MURPHY OT
Practice Location Address:

1280 S 3RD ST W STE 1
MISSOULA, MT
59801-2392

Practice Phone: 406-830-4500
Practice Fax: 406-258-0849

1366593345 — UNIVERSITY OF MONTANA
Practice Location Address:

634 EDDY AVE
MISSOULA, MT
59801

Practice Phone: 406-243-5171
Practice Fax: 406-243-6185

1194671313 — MARY BAYLIE
Practice Location Address:

1555 MILWAUKEE WAY APT 305
MISSOULA, MT
59801-3017

Practice Phone: 303-718-3486
Practice Fax:

Directions to “PROVIDENCE HEALTH & SERVICES MT ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.