| Providence Health & Services Mt | |
|
3075 N Reserve St Suite Q Missoula MT 59808-1390 | |
| (406) 327-1850 | |
| (406) 327-1875 |
| Full Name | Providence Health & Services Mt |
|---|---|
| Speciality | Family Medicine |
| Location | 3075 N Reserve St, Missoula, Montana |
| Authorized Official Name and Position | Donald W Anderson (ASSISTANT SECRETARY ENROLLMENT) |
| Authorized Official Contact | 4253589786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Health & Services Mt Po Box 31001 - 4114 Pasadena CA 91110-4114 Ph: () - | Providence Health & Services Mt 3075 N Reserve St Suite Q Missoula MT 59808-1390 Ph: (406) 327-1850 |
| NPI Number | 1790931517 |
|---|---|
| Provider Enumeration Date | 08/12/2008 |
| Last Update Date | 05/07/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790931517 | NPI | - | NPPES |
| 8445 | Other | MT | MEDICAL LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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