| 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 | 05/28/2024 |
| Certification Date | 05/27/2024 |
| Medicare PECOS PAC ID | 6608786306 |
|---|---|
| Medicare Enrollment ID | O20190116003053 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215222617 | NPI | - | NPPES |
| Provider Name | Joshua Jones |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548361009 PECOS PAC ID: 5395844591 Enrollment ID: I20240126003056 |
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