Providence Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

10708 Issued in MT

Legal business name

PROVIDENCE SURGERY CENTER

Practice address

902 N Orange St
Missoula, MT 59802-2916

Phone

(406) 327-3300

Fax

(406) 327-3302

NPI assigned

Jul 29, 2006

Organization subpart

No

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

Authorized official

Name

Shelley Longgood, RN

Title

Administrator

Phone

(406) 327-3300

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MT

Enrollment records 1

Listed as

Providence Surgery CenterCCN 27C0001012

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Providence Health & Services Mt

  • Cardiovascular Disease Physician
  • St. Ignatius, MT
  • NPI 1568629038

  Member Of

  NPD member
• Western Montana Clinic PC

  • Clinical Medical Laboratory
  • Missoula, MT
  • NPI 1740364017

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gary J Willstein, MD

  • Orthopaedic Surgery Physician
  • Missoula, MT
  • NPI 1932154671
  NPD (past)

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735603200000",
    "number": "1407860745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 N ORANGE ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598022916",
            "telephone_number": "406-327-3300",
            "fax_number": "406-327-3302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 N ORANGE ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598022916",
            "telephone_number": "406-327-3300",
            "fax_number": "406-327-3302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A",
        "authorized_official_last_name": "LONGGOOD",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "406-327-3300",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MT",
            "license": "10708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0350098",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Providence Health & Services Mt
• Providence Health & Services Mt
• Providence Health & Services Mt
• Providence Health & Services Mt
• Providence Health & Services Mt
• Kristene A Provo, PAC
• Timothy Paul Provow, M.D.
• Pruyn Veterinary Hospital, LLC
• Andrew Pryne, PHARMD
• Elif Pryor, DDS

• Ambulatory Surgical Clinic/Center in Missoula, MT
• Providers in Missoula, MT by specialty
• Ambulatory Surgical Clinic/Center in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.