NPIMap

Organization Active NPI

Providence St Joseph Medical Center

Doing business as Prov St Joseph Med Ctr RC

  • Assisted Living Facility
  • Polson, MT
National Provider Identifier
1285796920
Registry record updated Apr 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
10123 Issued in MT
Legal business name
PROVIDENCE ST JOSEPH MEDICAL CENTER
Doing business as
Prov St Joseph Med Ctr RC
Practice address
11 17TH Ave E
Polson, MT 59860-4083
Phone
(406) 883-1011
NPI assigned
Dec 15, 2006
Last updated
Apr 5, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 5, 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 Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 10123 MT Primary

Addresses

Primary practice location

11 17TH Ave E
Polson, MT 59860-4083

Mailing address

PO Box 31001-4110
Pasadena, CA 91110-4110
Phone (406) 883-1011

Other identifiers 1

IdentifierTypeStateIssuer
810628MedicaidMT

Other names 1

  • Prov St Joseph Med Ctr RC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Orthopedic and Sport7 organizations share this tax ID, including this one
Part of
Providence Service Corporation

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743811200000",
    "number": "1285796920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4110",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104110",
            "telephone_number": "406-883-1011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 17TH AVE E",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598604083",
            "telephone_number": "406-883-1011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE ST JOSEPH MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES",
        "enumeration_date": "2006-12-15",
        "last_updated": "2025-04-05",
        "certification_date": "2025-04-05",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MT",
            "license": "10123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "810628",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prov St Joseph Med Ctr RC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Polson, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.