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

Coty John Holm

Individual provider Surgical Physician Assistant · NPI 1902453855

Coty John Holm is a Physician Assistant in Missoula, Montana. Qualified in 2020, 6 years ago. Practices with Providence Health and Services Mt, a 358-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Montana.

Years since qualifying
6
Licensed in
MT
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

500 W Broadway St
Missoula, MT 59802-4008
Phone: (406) 329-5615
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4311 11th Avenue Ne, Seattle, WA 98105-6367 — (206) 616-4001

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence MED-PAC-LIC-91036 (MT)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1902453855
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedAugust 23, 2019
Last updated in NPPESMay 21, 2021
Certification dateMay 21, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Providence Health And Services Mt — 358 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Missoula