NPIMap

Organization Active NPI

Providence Health & Services Mt

Doing business as PMG MT Montana Internal Med

  • Internal Medicine Physician
  • Missoula, MT
National Provider Identifier
1730325440
Registry record updated Sep 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0411866 Issued in MT
Legal business name
PROVIDENCE HEALTH & SERVICES MT
Doing business as
PMG MT Montana Internal Med
Providence Medical Group Montana
Practice address
2819 Great Northern Loop
Suite 200
Missoula, MT 59808-1750
Phone
(406) 543-1197
Fax
(406) 543-0515
NPI assigned
Dec 30, 2008
Last updated
Sep 17, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH & SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 17, 2026

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 Enrollment
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 0411866 MT Primary

Addresses

Primary practice location

2819 Great Northern Loop
Suite 200
Missoula, MT 59808-1750

Mailing address

PO Box 31001 - 4114
Pasadena, CA 91110-4114
Phone (406) 327-1918

Other names 2

  • PMG MT Montana Internal Med Doing business as
  • Providence Medical Group Montana Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

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…

National Provider Directory

National Provider Directory
Part of
St Patrick Hospital Corp

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.

NPI Registry JSON

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

{
    "created_epoch": "1230595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789603200000",
    "number": "1730325440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 4114",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911104114",
            "telephone_number": "406-327-1918",
            "fax_number": "406-329-2937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2819 GREAT NORTHERN LOOP",
            "address_2": "SUITE 200",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598081750",
            "telephone_number": "406-543-1197",
            "fax_number": "406-543-0515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH & SERVICES MT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH & SERVICES",
        "enumeration_date": "2008-12-30",
        "last_updated": "2026-09-17",
        "certification_date": "2026-09-17",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENT",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MT",
            "license": "0411866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PMG MT Montana Internal Med",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PMG MT Montana Internal Med",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Medical Group Montana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.