NPIMap

Organization Active NPI

Providence Health & Services Mt

Doing business as PMG MT Wound Care

  • Endocrinology, Diabetes & Metabolism Physician
  • Missoula, MT
National Provider Identifier
1235370065
Registry record updated Sep 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
PROVIDENCE HEALTH & SERVICES MT
Doing business as
PMG MT Wound Care
Providence Medical Group Montana
Practice address
500 W Broadway St Ste 210
Missoula, MT 59802-4008
Phone
(406) 329-5736
NPI assigned
Mar 6, 2009
Last updated
Sep 16, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 16, 2026

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary Enrollments
Phone
(425) 358-9786

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered Nurse 163WW0000X
Endocrinology, Diabetes & Metabolism Physician 207RE0101X Primary

Addresses

Primary practice location

500 W Broadway St Ste 210
Missoula, MT 59802-4008

Mailing address

PO Box 31001 - 4114
Pasadena, CA 91110-4114
Phone (406) 327-5734

Other names 2

  • PMG MT Wound Care Doing business as
  • PROVIDENCE MEDICAL GROUP MONTANA Doing business as

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
Tax ID family
Weston Mark G39 organizations share this tax ID, including this one
Part of
Providence Service Corporation

Other organizations with this tax ID 38

Organizations that report the same tax identification number in the National Provider Directory.

View all 38

Locations

500 W Broadway St
Fl 1
Missoula, MT 59802

500 W Broadway St
Ste 210
Missoula, MT 59802
Phone (406) 329-5736

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1236297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789516800000",
    "number": "1235370065",
    "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",
            "telephone_number": "406-327-5734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST STE 210",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008",
            "telephone_number": "406-329-5736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES MT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES",
        "enumeration_date": "2009-03-06",
        "last_updated": "2026-09-16",
        "certification_date": "2026-09-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PMG MT Wound Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PMG MT Wound Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PROVIDENCE MEDICAL GROUP MONTANA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2026; 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.