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

Providence Health & Services Mt

Organization Family Medicine Physician · NPI 1790931517

Providence Health & Services Mt is a Family Medicine Physician in Missoula, Montana. Registered with an NPI since 2008.

In the registry since
2008

Practice location Address checks out

3075 N Reserve St Ste Q
Missoula, MT 59808-1390
Phone: (406) 327-1850
Fax: (406) 327-1875
Show map & directions

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

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X

Record details

NPI number1790931517
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationProvidence Health & Services
Authorized official Donald Anderson — Assistant Secretary Enrollment · (425) 358-9786
Other names Pmg Mt Grant Creek Family Med; Providence Medical Group Montana
NPI enumeratedAugust 12, 2008
Last updated in NPPESMay 7, 2025
Certification dateMay 7, 2025
Mailing addressPo Box 31001 - 4114, Pasadena, CA 91110-4114

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