| Providence Medical Group Mt - Mdpp | |
|
900 N Orange St Ste 304 Missoula MT 59802-2951 | |
| (406) 329-5781 | |
| (406) 327-3331 |
| Full Name | Providence Medical Group Mt - Mdpp |
|---|---|
| Speciality | Clinic/Center |
| Location | 900 N Orange St Ste 304, Missoula, Montana |
| Authorized Official Name and Position | Donald Wayne Anderson (ASST SEC FOR ENROLLMENT/DIR REIMB A) |
| 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 Mt - Mdpp 900 N Orange St Ste 304 Missoula MT 59802-2951 Ph: (406) 329-5781 | Providence Medical Group Mt - Mdpp 900 N Orange St Ste 304 Missoula MT 59802-2951 Ph: (406) 329-5781 |
| NPI Number | 1881191948 |
|---|---|
| Provider Enumeration Date | 04/06/2018 |
| Last Update Date | 04/06/2018 |
| Medicare PECOS PAC ID | 6608786306 |
|---|---|
| Medicare Enrollment ID | O20190315001535 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881191948 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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