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NPI Code Detail

MEDICARE: PROVIDENCE HEALTH & SERVICES MT

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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18445OTHERMTMEDICAL LICENSE NUMBER

General Provider Information

NPI Number : 1790931517
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 : 3075 N RESERVE ST
Second Line : SUITE Q
City : MISSOULA
State : MT
Zip : 59808-1390
Country : US
Telephone Number : 406-327-1850
Fax Number : 406-327-1875
Authorized Official
Title or Position : ASSISTANT SECRETARY ENROLLMENT
Name : MR. DONALD W ANDERSON JR.
Credential :
Telephone Number : 425-358-9786
Provider Enumeration Date : 08/12/2008
Last Update Date : 05/07/2025

Similar Medicare Providers

1316605637 — PROVIDENCE HEALTH & SERVICES MT
Practice Location Address:
3075 N RESERVE ST STE Q
MISSOULA, MT
59808-1390
Practice Phone: 406-327-1850
Practice Fax:
1487727889 — DR. MEREDITH ALEXIA LEASE M.D.
Practice Location Address:
3075 N RESERVE ST STE Q
MISSOULA, MT
59808-1390
Practice Phone: 406-327-1850
Practice Fax: 406-327-1875
1639297674 — JASON PATRICK WISSINGER MD
Practice Location Address:
3075 N RESERVE ST STE Q
MISSOULA, MT
59808-1390
Practice Phone: 406-327-1850
Practice Fax: 406-327-1875
1932434511 — MRS. HEATHER MARIE SHORTRIDGE PA-C
Practice Location Address:
3075 N RESERVE ST STE Q
MISSOULA, MT
59808-1390
Practice Phone: 406-327-1750
Practice Fax: 406-327-1960
1568808525 — JENNIFER WILKINSON M.D.
Practice Location Address:
3075 N RESERVE ST STE Q
MISSOULA, MT
59808-1390
Practice Phone: 406-327-1850
Practice Fax: 406-327-1875
1427484989 — TERESA C RODRIGUEZ PA-C
Practice Location Address:
3075 N RESERVE ST STE Q
MISSOULA, MT
59808-1390
Practice Phone: 406-327-1850
Practice Fax: 406-327-1875

Directions to “PROVIDENCE HEALTH & SERVICES MT ” Practice Location

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