| Providence Medical Group Montana | |
|
500 W Broadway St Missoula MT 59802-4008 | |
| (406) 543-7271 | |
| Not Available |
| Full Name | Providence Medical Group Montana |
|---|---|
| Speciality | Family Medicine |
| Location | 500 W Broadway St, Missoula, Montana |
| Authorized Official Name and Position | Donald W Anderson (DIR REIMB REG STRAT/ASST SEC ENROLL) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Medical Group Montana Po Box 12 Liberty Lake WA 99019-0012 Ph: (406) 543-7271 | Providence Medical Group Montana 500 W Broadway St Missoula MT 59802-4008 Ph: (406) 543-7271 |
| NPI Number | 1215222617 |
|---|---|
| Provider Enumeration Date | 06/14/2011 |
| Last Update Date | 10/01/2020 |
| Medicare PECOS PAC ID | 6608786306 |
|---|---|
| Medicare Enrollment ID | O20190125001690 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215222617 | NPI | - | NPPES |
| Provider Name | Cynthia P Bartley |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1467523951 PECOS PAC ID: 3476540337 Enrollment ID: I20040430000728 |
| Provider Name | Shannon E Jackson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558301168 PECOS PAC ID: 0446352827 Enrollment ID: I20070305000236 |
| Provider Name | Laura J Kim |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1083737266 PECOS PAC ID: 5193817468 Enrollment ID: I20070816000829 |
| Provider Name | Xiang-hong Song |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1043327109 PECOS PAC ID: 3375628571 Enrollment ID: I20080312000416 |
| Provider Name | Paula Gerber-gore |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1518156504 PECOS PAC ID: 0143392464 Enrollment ID: I20080702000197 |
| Provider Name | Lauren A Cooper |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1497833578 PECOS PAC ID: 2163437021 Enrollment ID: I20080722000774 |
| Provider Name | Theodore J Lowenkopf |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1629059407 PECOS PAC ID: 8921165606 Enrollment ID: I20090324000675 |
| Provider Name | James M Martinson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144232554 PECOS PAC ID: 5294859740 Enrollment ID: I20100903000959 |
| Provider Name | John F Zurasky |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1255337572 PECOS PAC ID: 9234109802 Enrollment ID: I20110118000751 |
| Provider Name | Amit C Kansara |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1104093665 PECOS PAC ID: 4486817541 Enrollment ID: I20120530000096 |
| Provider Name | Archit C Bhatt |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1750574547 PECOS PAC ID: 0648394155 Enrollment ID: I20120904000561 |
| Provider Name | Andrew D Rontal |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1063657328 PECOS PAC ID: 7911150065 Enrollment ID: I20130710000362 |
| Provider Name | Lilith M Judd |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1508032327 PECOS PAC ID: 8921263419 Enrollment ID: I20140826000192 |
| Provider Name | Biggya L Sapkota |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1306006135 PECOS PAC ID: 0244405272 Enrollment ID: I20151007003377 |
| Provider Name | Pawani Sachar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1689955536 PECOS PAC ID: 9234421413 Enrollment ID: I20161121000373 |
| Provider Name | Jesse Dean Matthews |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851566822 PECOS PAC ID: 6204007040 Enrollment ID: I20190122002682 |
| Provider Name | Bruce Geryk |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1275794802 PECOS PAC ID: 5092933846 Enrollment ID: I20190422001901 |
| Provider Name | Ryan M Argyle |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1942614292 PECOS PAC ID: 0042439846 Enrollment ID: I20191028003227 |
| Provider Name | Kishan Sunilbhai Patel |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1962889634 PECOS PAC ID: 3375878036 Enrollment ID: I20200612002356 |
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