OrganizationActive
Providence Health & Services Mt
NPI 1124268966 · Emergency Medical Services (Emergency Medicine) Physician · Missoula, MT
Provider details
- NPI number
- 1124268966
- Entity type
- Organization
- Primary specialty
- Emergency Medical Services (Emergency Medicine) PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Providence Health & Services
- Organization subpart
- Yes
- Authorized official
- Donald Anderson, Assistant Secretary Enrollment(425) 358-9786
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Emergency Medicine Physician207P00000X
Allopathic & Osteopathic Physicians
Practice location
500 W Broadway St
Missoula, MT 59802-4008
Phone: (406) 327-1918
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 12
Liberty Lake, WA 99019-0012
Other names (DBA / former)
- Doing business as
- Pmg Mt Trauma Services
- Doing business as
- Pmg Mt Trauma Services
- Doing business as
- Providence Medical Group Montana
Registry dates
- Enumerated
- 2009-03-05
- Last updated
- 2025-05-05
- Certified
- 2025-05-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.