Active NPI
Providence Health & Services Mt
Doing business as Providence Medical Group MT - MDPP
- Clinic/Center
- Missoula, MT
National Provider Identifier
1881191948
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- PROVIDENCE HEALTH & SERVICES MT
- Doing business as
- Providence Medical Group MT - MDPP
- Practice address
- 900 N Orange St Ste 304
Missoula, MT 59802-2951 - Phone
- (406) 329-5781
- Fax
- (406) 327-3331
- NPI assigned
- Apr 6, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Donald Wayne Anderson Jr.
- Title
- Assistant Secretary Enrollments
- Phone
- (425) 358-9786
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Metabolic Nutrition Registered Dietitian | 133VN1006X | |||
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
900 N Orange St Ste 304
Missoula, MT 59802-2951
Mailing address
PO Box 31001 - 4114
Pasadena, CA 91110-4114
Other names 1
- Providence Medical Group MT - MDPP
National Provider Directory
National Provider DirectoryLocations
900 N Orange St
Ste 304
Missoula, MT 59802
Phone (406) 329-5781
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522972800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1746576000000",
"number": "1881191948",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 N ORANGE ST STE 304",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598022951",
"telephone_number": "406-329-5781",
"fax_number": "406-327-3331"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROVIDENCE HEALTH & SERVICES MT",
"organizational_subpart": "NO",
"enumeration_date": "2018-04-06",
"last_updated": "2025-05-07",
"certification_date": "2025-05-07",
"status": "A",
"authorized_official_last_name": "ANDERSON",
"authorized_official_first_name": "DONALD",
"authorized_official_middle_name": "WAYNE",
"authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
"authorized_official_telephone_number": "425-358-9786",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "133VN1006X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dietitian, Registered, Nutrition, Metabolic",
"state": null,
"license": null,
"primary": false
},
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Providence Medical Group MT - MDPP",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Providence Medical Group MT - MDPP",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Missoula, MT
- Providence Health & Services Mt (PMG MT Pediatrics)
- Providence Health & Services Mt (SPH First Step)
- Providence Health & Services Mt (PMG MT Lng Term Mobility Care)
- Providence Health & Services Mt (PMG MT Grant Creek Family Med)
- Providence Health & Services Mt (1871825018)
- Providence Health & Services Mt (PMG MT General Surgery)
- Providence Surgery Center
- Kristene A Provo, PAC
- Timothy Paul Provow, M.D.
- Pruyn Veterinary Hospital, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.