| Prov St Joseph Med Ctr | |
|
6 13th Ave E Polson MT 59860-5315 | |
| (406) 883-5377 | |
| Not Available |
| Full Name | Prov St Joseph Med Ctr |
|---|---|
| Speciality | Family Medicine |
| Location | 6 13th Ave E, Polson, Montana |
| Authorized Official Name and Position | Donald Wayne Anderson (ASST SEC FOR ENROLLMENT/DIR REIMB S) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prov St Joseph Med Ctr Po Box 262 Liberty Lake WA 99019-0262 Ph: (406) 883-5377 | Prov St Joseph Med Ctr 6 13th Ave E Polson MT 59860-5315 Ph: (406) 883-5377 |
| NPI Number | 1669655528 |
|---|---|
| Provider Enumeration Date | 12/13/2007 |
| Last Update Date | 02/12/2021 |
| Medicare PECOS PAC ID | 0446230247 |
|---|---|
| Medicare Enrollment ID | O20040910001134 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669655528 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Alan W Thomas |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1548297468 PECOS PAC ID: 9638062755 Enrollment ID: I20040203001067 |
| Provider Name | Michael J Snyder |
|---|---|
| Provider Type | Practitioner - Hematology |
| Provider Identifiers | NPI Number: 1306872999 PECOS PAC ID: 0749173490 Enrollment ID: I20040205000862 |
| Provider Name | Kenneth Carl Brewington |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1154315695 PECOS PAC ID: 6204720576 Enrollment ID: I20040209001234 |
| Provider Name | James T Maddux |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1942237326 PECOS PAC ID: 1557357605 Enrollment ID: I20040422001742 |
| Provider Name | Phillip A Gardner |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1003843897 PECOS PAC ID: 1850356569 Enrollment ID: I20041122001102 |
| Provider Name | Kelly G Bagnell |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1558390617 PECOS PAC ID: 0244277101 Enrollment ID: I20050412000843 |
| Provider Name | Richard S Irwin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528093382 PECOS PAC ID: 9436196300 Enrollment ID: I20050412000918 |
| Provider Name | Bradley D Berry |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1326083023 PECOS PAC ID: 8820038789 Enrollment ID: I20050510000653 |
| Provider Name | Linda M Ries |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1922034693 PECOS PAC ID: 1658315908 Enrollment ID: I20050616001022 |
| Provider Name | Brooke J Lund |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1992860944 PECOS PAC ID: 9335244185 Enrollment ID: I20070424000070 |
| Provider Name | Michele A Danicich |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1053321273 PECOS PAC ID: 1759475585 Enrollment ID: I20070924000477 |
| Provider Name | Simone Musco |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1013181833 PECOS PAC ID: 6901974252 Enrollment ID: I20081014000294 |
| Provider Name | Jeffrey C Knight |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1528102399 PECOS PAC ID: 9739274499 Enrollment ID: I20081216000369 |
| Provider Name | Charlotte R Nelson |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1033395546 PECOS PAC ID: 7911061932 Enrollment ID: I20090205000258 |
| Provider Name | Judith L Gustafson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851554471 PECOS PAC ID: 7012074180 Enrollment ID: I20090318000168 |
| Provider Name | Rebecca L Bontadelli |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275729519 PECOS PAC ID: 5294802518 Enrollment ID: I20090827000848 |
| Provider Name | John D A Lakatua |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1023063070 PECOS PAC ID: 4789726878 Enrollment ID: I20100128000071 |
| Provider Name | Alexander B Jehle |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1790831329 PECOS PAC ID: 8123932456 Enrollment ID: I20100209000362 |
| Provider Name | Lorina K Massey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215187588 PECOS PAC ID: 9436293255 Enrollment ID: I20100217000664 |
| Provider Name | Jamie G Straub |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1295762714 PECOS PAC ID: 2567594633 Enrollment ID: I20100726000328 |
| Provider Name | Sarah M Scott |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1144335530 PECOS PAC ID: 6709942329 Enrollment ID: I20100825001049 |
| Provider Name | Jeffrey Haller |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1194712307 PECOS PAC ID: 0840182689 Enrollment ID: I20100917000158 |
| Provider Name | Michael C Reed |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1346396967 PECOS PAC ID: 8729187190 Enrollment ID: I20110921000644 |
| Provider Name | Peter G Vondoersten |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1619962990 PECOS PAC ID: 3173415817 Enrollment ID: I20111104000424 |
| Provider Name | Ryan D Adams |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1790952653 PECOS PAC ID: 3375695984 Enrollment ID: I20111201000697 |
| Provider Name | Jocelyn Nichole Spoon |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1548427644 PECOS PAC ID: 6103958343 Enrollment ID: I20140815001090 |
| Provider Name | Amy M Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386058345 PECOS PAC ID: 5496973620 Enrollment ID: I20140828002543 |
| Provider Name | Adeline Wakeman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427301589 PECOS PAC ID: 6709008204 Enrollment ID: I20141118002221 |
| Provider Name | Wendy Terese Grace |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1265743348 PECOS PAC ID: 3779720693 Enrollment ID: I20150205000716 |
| Provider Name | Wanda Lynn King |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1154730364 PECOS PAC ID: 6002131315 Enrollment ID: I20150209000925 |
| Provider Name | Benjamin Grass |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467894121 PECOS PAC ID: 1759607492 Enrollment ID: I20150224000869 |
| Provider Name | Penny Lynn Starkel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336124072 PECOS PAC ID: 9830172501 Enrollment ID: I20150309001551 |
| Provider Name | Kari Mazur |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871797340 PECOS PAC ID: 7416023692 Enrollment ID: I20150511001939 |
| Provider Name | Nichole Marie Mckinsey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790046035 PECOS PAC ID: 6800109075 Enrollment ID: I20150716001715 |
| Provider Name | Maria Mcneil Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134501117 PECOS PAC ID: 0749596716 Enrollment ID: I20150904002509 |
| Provider Name | Stephen S Campbell |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1174535132 PECOS PAC ID: 3971694738 Enrollment ID: I20151202001007 |
| Provider Name | Daniel Bradley Spoon |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1104021781 PECOS PAC ID: 4486790110 Enrollment ID: I20160817002475 |
| Provider Name | Nick Furlong |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1366718579 PECOS PAC ID: 8022245935 Enrollment ID: I20160819000548 |
| Provider Name | Sadie R Russell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578914396 PECOS PAC ID: 9638465644 Enrollment ID: I20160830003018 |
| Provider Name | John Merrill Neathawk |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134567126 PECOS PAC ID: 2668694548 Enrollment ID: I20160908000805 |
| Provider Name | Amy S Davis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497003354 PECOS PAC ID: 9830470426 Enrollment ID: I20161219001517 |
| Provider Name | Christopher J Maki |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1871806117 PECOS PAC ID: 8820307986 Enrollment ID: I20170113002478 |
| Provider Name | Michael Patrick Wright |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1982903183 PECOS PAC ID: 6507167772 Enrollment ID: I20170919001914 |
| Provider Name | Camilla E Juhl-petersen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073809232 PECOS PAC ID: 2769637768 Enrollment ID: I20171107001581 |
| Provider Name | Kevin Thomas Lienesch |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1356794721 PECOS PAC ID: 9133460702 Enrollment ID: I20190409000471 |
| Provider Name | Elizabeth Nicole Bassler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932601796 PECOS PAC ID: 6305187501 Enrollment ID: I20190417001101 |
| Provider Name | Edwin Stuart Palmer |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922426113 PECOS PAC ID: 5496971103 Enrollment ID: I20190823001585 |
| Provider Name | Ivy Jenkins |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1104043082 PECOS PAC ID: 6507957040 Enrollment ID: I20200408003471 |
| Provider Name | Colleen Weseloh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962820100 PECOS PAC ID: 1456653393 Enrollment ID: I20200413003727 |
| Provider Name | Nicholas Mantini |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1588808646 PECOS PAC ID: 5193963205 Enrollment ID: I20200714000997 |
| Provider Name | Amy Renee Richmond |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366975252 PECOS PAC ID: 6901150564 Enrollment ID: I20200914002416 |
| Provider Name | Jon Mcgregor |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1619925575 PECOS PAC ID: 5991785156 Enrollment ID: I20201016000294 |
| Provider Name | Michelle G Merchant |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1285052134 PECOS PAC ID: 1456634823 Enrollment ID: I20201104002405 |
| Provider Name | Danielle Herbst |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285238873 PECOS PAC ID: 8123430113 Enrollment ID: I20201216000614 |
| Provider Name | Megan Ransford Tullis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912503566 PECOS PAC ID: 6406260108 Enrollment ID: I20210120001813 |
| Provider Name | Christopher A Martin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306289707 PECOS PAC ID: 9638453780 Enrollment ID: I20210128000369 |
| Provider Name | Michael Dumouchel |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1982902367 PECOS PAC ID: 1052572195 Enrollment ID: I20210323002574 |
| Provider Name | Aron Haire |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1396242392 PECOS PAC ID: 8527460765 Enrollment ID: I20210712001326 |
| Provider Name | Emily Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750744942 PECOS PAC ID: 1951737048 Enrollment ID: I20210726003439 |
| Provider Name | Krista Birkelo |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1649435165 PECOS PAC ID: 2163695842 Enrollment ID: I20210907002078 |
| Provider Name | Christopher Williams |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1871821744 PECOS PAC ID: 9335361245 Enrollment ID: I20220504002160 |
| Provider Name | Lisa A Flora |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1821059718 PECOS PAC ID: 3577573500 Enrollment ID: I20220527001225 |
| Provider Name | Mark Dalton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093782138 PECOS PAC ID: 7517055890 Enrollment ID: I20220630002633 |
| Provider Name | Arfaat Khan |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1538379144 PECOS PAC ID: 5496800294 Enrollment ID: I20230523002019 |
| Provider Name | Leslie Anne Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750005989 PECOS PAC ID: 6103286158 Enrollment ID: I20230721001947 |
| Provider Name | Benjamin O Lawson |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1154717775 PECOS PAC ID: 3971896887 Enrollment ID: I20230724001294 |
| Provider Name | Matthew J Anderson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1033641550 PECOS PAC ID: 0648518092 Enrollment ID: I20230724004049 |
| Provider Name | Joseph F Smith |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1225423239 PECOS PAC ID: 0244544450 Enrollment ID: I20230725004173 |
| Provider Name | Carrie Lynn Millstead |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598442113 PECOS PAC ID: 2961865969 Enrollment ID: I20230823003612 |
| Provider Name | Sheila R.m. Reash |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1093755183 PECOS PAC ID: 7810903747 Enrollment ID: I20230913001417 |
| Provider Name | Naomi Onaka |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1932720224 PECOS PAC ID: 0042632028 Enrollment ID: I20230928002221 |
| Provider Name | Jacqueline A Eubany |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1912986944 PECOS PAC ID: 6204882277 Enrollment ID: I20231006002343 |
| Provider Name | Susan C Weaselhead |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1306296249 PECOS PAC ID: 6305280066 Enrollment ID: I20240221001822 |
St. Luke Community Clinic Polson Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 104 Rufus Ln, Polson, MT 59860 Phone: 406-883-2555 Fax: 406-883-2559 | |
Dogwood Counseling Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2 6th Ave E, Polson, MT 59860 Phone: 828-634-1806 | |
Wholeness In Health House-call Clinic Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 37926 Mt Highway 35, Polson, MT 59860 Phone: 406-261-5019 Fax: 406-883-6465 | |
Polson Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 102 13th Ave E, Polson, MT 59860 Phone: 406-751-5311 Fax: 406-257-2010 | |
Polson Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 106 Ridgewater Dr Ste A, Polson, MT 59860 Phone: 406-883-3200 Fax: 406-883-9483 | |
Prov St Joseph Med Ctr Polson Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6 13th Ave E, Polson, MT 59860 Phone: 406-883-5680 Fax: 406-883-8926 |