NPIMap

Organization Active NPI

Providence Health & Services Mt

  • General Acute Care Hospital
  • Stevensville, MT
National Provider Identifier
1053613356
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PROVIDENCE HEALTH & SERVICES MT
Practice address
715 Main Street
Ste a
Stevensville, MT 59870-2861
Phone
(406) 777-5522
Fax
(406) 541-7001
NPI assigned
Nov 19, 2010
Last updated
May 6, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donald Wayne Anderson Jr.
Title
Assistant Secretary Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU Primary

Addresses

Primary practice location

715 Main Street
Ste a
Stevensville, MT 59870-2861

Mailing address

PO Box 31001 - 4114
Pasadena, CA 91110-4114

Other names 1

  • PMG MT IHI Stevensville Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031229000787 MT Part B Supplier - Clinic/Group Practice 6608786306 Receives reassigned benefits from 382 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Missoula, MT; Plains, MT; Polson, MT; St Ignatius, MT; Stevensville, MT; Anaconda, MT; Butte, MT; Corvallis, MT…

National Provider Directory

National Provider Directory
Part of
Providence Service Corporation

Locations

500 W Broadway St
Fl 4
Missoula, MT 59802
Phone (406) 327-1900

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1290124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746489600000",
    "number": "1053613356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 4114",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 MAIN STREET",
            "address_2": "STE A",
            "city": "STEVENSVILLE",
            "state": "MT",
            "postal_code": "598702861",
            "telephone_number": "406-777-5522",
            "fax_number": "406-541-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES MT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES",
        "enumeration_date": "2010-11-19",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PMG MT IHI Stevensville",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Stevensville, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.