Providence Health & Services Mt
Organization Active NPI Clinic/Center · Missoula, MT
NPI 1598064628 · NPPES record last updated May 5, 2025
Key facts
- NPI
- 1598064628
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- PROVIDENCE HEALTH & SERVICES MT
- Practice address
- 601 W Spruce St
Suite a
Missoula, MT 59802-4057 - Phone
- (406) 329-2945
- Fax
- (406) 329-2938
- NPI assigned
- Mar 15, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- PROVIDENCE HEALTH & SERVICES
Authorized official
- Name
- Donald Wayne Anderson Jr.
- Title
- Assistant Secretary Enrollments
- Phone
- (425) 358-9786
Corporate family (same tax ID) 38
Practitioners 7
-
Rebecca B Hoover, MD
-
Simone Musco, MD
-
Stephanie Elizabeth Tripp, PHYSICIAN ASSISTANT
-
Steven Wheeler, FNP
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 |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
601 W Spruce St
Suite a
Missoula, MT 59802-4057
Mailing address
PO Box 34439
Seattle, WA 98124-1439
Phone (406) 329-2945
Other names
- PMG MT IHI CPAM
Other providers in Missoula, MT
- Providence Health & Services Mt
- Providence Health & Services Mt
- Providence Health & Services Mt
- Providence Health & Services Mt
- Providence Health & Services Mt
- Providence Health & Services Mt
- Providence Health & Services Mt
- Providence Health & Services Mt
- Providence Health & Services Mt
- Providence Health & Services Mt
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 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.