Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Providence Health & Services Mt

Organization Emergency Medicine Physician · NPI 1124268966

Providence Health & Services Mt is an Emergency Medicine Physician in Missoula, Montana. Registered with an NPI since 2009.

In the registry since
2009
Specialties on file
2

Practice location Address checks out

500 W Broadway St
Missoula, MT 59802-4008
Phone: (406) 327-1918
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emergency Medical Services (Emergency Medicine) Physician (primary) Taxonomy 207PE0004X
Emergency Medicine Physician Taxonomy 207P00000X

Record details

NPI number1124268966
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationProvidence Health & Services
Authorized official Donald Anderson — Assistant Secretary Enrollment · (425) 358-9786
Other names Pmg Mt Trauma Services; Pmg Mt Trauma Services; Providence Medical Group Montana
NPI enumeratedMarch 5, 2009
Last updated in NPPESMay 5, 2025
Certification dateMay 5, 2025
Mailing addressPo Box 12, Liberty Lake, WA 99019-0012

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