PROVIDENCE HEALTH & SERVICES MT – NPI #1124268966
Emergency Medicine

An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients.

PROVIDENCE HEALTH & SERVICES MT is a provider located in MISSOULA, MT. NPPES has assigned the NPI number 1124268966 to PROVIDENCE HEALTH & SERVICES MT on March 05, 2009. It is a Type-2 NPI, indicating this NPI number is associated with an organization. This provider is also associated with 2 additional names listed below. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 207PE0004X from the Health Care Provider Taxonomy code set, which is classified as Emergency Medicine, specializing in Emergency Medical Services

The NPI profile was last updated on May 05, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for PROVIDENCE HEALTH & SERVICES MT below.

NPI Profile for
PROVIDENCE HEALTH & SERVICES MT

NPI Number
1124268966
Enumeration Date

(more than 17 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PROVIDENCE HEALTH & SERVICES MT
Other name(s)
All associated names:
Doing Business As (dba)
PMG MT Trauma Services
Doing Business As (dba)
PROVIDENCE MEDICAL GROUP MONTANA
Primary location
500 W BROADWAY ST
MISSOULA, MT 59802-4008
Phone: (406) 327-1918 Fax:
Mailing address
PO BOX 12
LIBERTY LAKE, WA 99019-0012
Phone: (406) 327-1918 Fax:
Organization Subpart
Yes - PROVIDENCE HEALTH & SERVICES MT is subpart of another organization.
Authorized Official
DONALD ANDERSON
ASSISTANT SECRETARY ENROLLMENT
Phone: (425) 358-9786
Updated
Certification Date
May 05, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207PE0004X
- Emergency Medicine / Emergency Medical Services (Primary)
207P00000X
- Emergency Medicine

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.