NPIMap

Organization Active NPI

Providence Health & Services Mt

Doing business as Montana Cancer Center at Providence St. Patrick Hospital

  • Medical Oncology Physician
  • Missoula, MT
National Provider Identifier
1326483587
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
License
13200 Issued in MT
Legal business name
PROVIDENCE HEALTH & SERVICES MT
Doing business as
Montana Cancer Center at Providence St. Patrick Hospital
Practice address
500 W Broadway St
Missoula, MT 59802-4008
Phone
(406) 728-2539
NPI assigned
May 1, 2013
Last updated
May 6, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICES MTAs 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 W Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Clinic/Center 261QX0203X
Medical Oncology Physician 207RX0202X 13200 MT Primary

Addresses

Primary practice location

500 W Broadway St
Missoula, MT 59802-4008

Mailing address

PO Box 31001-4110
Pasadena, CA 91110-4110

Other names 1

  • Montana Cancer Center at Providence St. Patrick Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT2 enrollments

Enrollment records 2

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…
O20051207001064 MT Part A Provider - Hospital 6608786306 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Missoula, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326483587. Details of each certification follow.

Hospital certification: CCN 270014

Legal name
PROVIDENCE HEALTH & SERVICES MT
Doing business as
PROVIDENCE ST PATRICK HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Mar 3, 2010
Beds
253
Ownership / control type
Church
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 1991 in MT
Enrollment address
500 W Broadway St
Missoula, MT 59802-4008
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Alcohol/drug

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
St. Patrick HospitalCCN 270014 · All quality measures
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Richard L Sellman MD

Ownership & related parties

All disclosed owners & managing parties 25

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Diane L Hejna Individual Corporate DirectorBoard Member Jul 1, 2016
Richard S Blair Individual Corporate DirectorBoard Member Jul 1, 2016
Marvin O'Quinn Individual Corporate DirectorBoard Member Jan 1, 2024
Linda Buck Individual Corporate DirectorBoard Member Jan 1, 2025
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit, Chain home office Operational/Managerial Control Jan 1, 1966
Mary E Lyons Individual Corporate DirectorBoard Member Jul 1, 2016
Kirk Francis Bodlovic Individual W-2 Managing EmployeeRegional Chief Operating Executive Jan 1, 2011
Phyllis M Hughes Individual Corporate DirectorBoard Member Jan 1, 2014
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
Joel Gilbertson Individual W-2 Managing Employee Mar 1, 2021
James Martin Individual Corporate OfficerAssistant Treasurer Jan 13, 2023
Charles Wallace Sorenson Individual Corporate OfficerBoard Member Jan 1, 2019
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary Enrollment Jan 1, 2017
Gregory David Hoffman Individual Corporate OfficerPresident/Ceo & Treasurer Oct 1, 2020
Providence Health & Services Mt Organization, Renton, WA Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2010 100%
Isiaah D Crawford Individual Corporate DirectorBoard Member Feb 1, 2012
Donna Markham Individual Corporate DirectorBoard Member Jan 1, 2024
Michael W Murphy Individual Corporate DirectorBoard Member Jan 1, 2020
Providence Health & Services Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Aug 13, 2008
Mary Beth Kingston Individual Corporate DirectorBoard of Directors Sep 1, 2022
Eric D Sprunk Individual Corporate Director Jan 1, 2022
Anna R Newsom Individual Corporate OfficerCorporate Secretary May 13, 2022
Darryl Elmouchi Individual Corporate OfficerPresident Apr 1, 2025
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Other Jul 1, 2016

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 4

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.

Affiliated clinicians 750

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 750

NPI Registry JSON

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

{
    "created_epoch": "1367366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746489600000",
    "number": "1326483587",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W BROADWAY ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024008",
            "telephone_number": "406-728-2539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES MT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES MT",
        "enumeration_date": "2013-05-01",
        "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": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QX0203X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oncology, Radiation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "MT",
            "license": "13200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Montana Cancer Center at Providence St. Patrick Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Montana Cancer Center at Providence St. Patrick Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.