Providence Health & Services Mt
Organization Active NPI Cardiovascular Disease Physician · Deer Lodge, MT
NPI 1407013261 · NPPES record last updated Jun 20, 2025
Key facts
- NPI
- 1407013261
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- Legal business name
- PROVIDENCE HEALTH & SERVICES MT
- Practice address
- 1101 Texas Ave
Deer Lodge, MT 59722-1828 - Phone
- (406) 846-1722
- Fax
- (406) 329-5606
- NPI assigned
- May 20, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- PROVIDENCE HEALTH & SERVICES
Authorized official
- Name
- Donald Wayne Anderson Jr.
- Title
- Assistant Secretary Enrollment
- Phone
- (425) 358-9786
Corporate family (same tax ID) 38
Practitioners 7
-
Nicholas Hurst, MD, MS
-
Melissa R. Robinson, M.D.
-
Michael J Rohrer, M.D.
-
James Otis Mudd, M.D.
-
Stephen A Nickisch, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Tax ID family
- Ihi Outreach
- Part of
- Providence Service Corporation
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician |
207RC0000X | Yes | ||
| Interventional Cardiology Physician |
207RI0011X | |||
| Pulmonary Disease Physician |
207RP1001X |
Addresses
Primary practice location
1101 Texas Ave
Deer Lodge, MT 59722-1828
Mailing address
PO Box 31001-4114
Pasadena, CA 91110-4114
Phone (406) 329-5615
Other names
- PMG MT IHI Deer Lodge
Other providers in Deer Lodge, MT
- Powell County Memorial Hospital Association Inc
- Powell County Memorial Hospital Association Inc
- Powell County Physical Therapy
- Powell Emergency Medical Service
- Premier Family Practice, P.C.
- Summera Qamar
- Thomas G. Rachie
- Frank Raiser
- Rand W Dickson Interstate Medical Transport
- John William Rausch Jr.
All providers in Deer Lodge, MT · Cardiovascular Disease Physician in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.