PROVIDENCE HEALTH & SERVICES MT (NPI# 1154562981) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154562981 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES MT |
| Other Organization Name | PMG MT PEDIATRIC HOSPITALISTS |
| Practice Address |
500 W Broadway St Missoula MT 59802-4096 |
| Mailing Address |
Po Box 34439 Seattle WA 98124-1439 |
| Practice Telephone | 4063271613 |
| Mailing Telephone | 4063271613 |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2011-06-29 |
| Authorized Official Name | TERI MASTERS (RCM OPERATIONS MGR) |
| Authorized Official Telephone | 4063295795 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE HEALTH & SERVICES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| PMG MT Pediatric Hospitalists | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326483587 | Providence Health & Services Mt | Internal Medicine | 24001 East Mission Ave. Ste 105, Providence Healtlh and Services, Montana, Liberty Lake, WA 99019-0012 | 2013-05-01 |
| 1679865497 | Providence Health & Services Mt | Physician Assistant | 3050 Highway 83 N, Seeley Lake, MT 59868 | 2011-05-12 |
| 1427281203 | Providence Health & Services Mt | Internal Medicine | 500 W Broadway Street, Missoula, MT 59802-4096 | 2009-08-27 |
| 1538394267 | Providence Health & Services Mt | Internal Medicine | 435 S Crystal St Ste 240, Butte, MT 59701-1523 | 2009-05-26 |
| 1871750554 | Providence Health & Services Mt | Internal Medicine | 300 W Mercury Street, Butte, MT 59701-1652 | 2008-05-20 |
| 1518124379 | Providence Health & Services Mt | Internal Medicine | 1102 E Commercial Ave, Anaconda, MT 59711-2718 | 2008-05-20 |
| 1881191948 | Providence Health & Services Mt | Clinic/Center | 900 N Orange St Ste 304, Missoula, MT 59802-2951 | 2018-04-06 |
| 1174074827 | Providence Health & Services Mt | Nurse Practitioner | 500 W Broadway St, Missoula, MT 59802-4008 | 2016-10-18 |
| 1720477953 | Providence Health & Services Mt | Neurological Surgery | 500 W Broadway St, Missoula, MT 59802-4008 | 2015-01-12 |
| 1215222617 | Providence Health & Services Mt | Internal Medicine | 500 W Broadway St, Missoula, MT 59802-4008 | 2011-06-14 |
| Street Address |
500 W BROADWAY ST |
| City | MISSOULA |
| State | MT |
| Zip Code | 59802-4096 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982600359 | Kendra B. Lee | Family Medicine | 500 W Broadway St, Missoula, MT 59802-4008 | 2005-06-21 |
| 1205468725 | Stephanie Elizabeth Carl | Physician Assistant | 500 W Broadway St, Missoula, MT 59802-4008 | 2020-02-12 |
| 1942840483 | Credena Health LLC | Durable Medical Equipment & Medical Supplies | 500 W Broadway St, Missoula, MT 59802-4008 | 2020-01-13 |
| 1346880119 | Kaylyn Casebolt Desrosier | Pharmacist | 500 W Broadway St, Missoula, MT 59802-4008 | 2020-01-09 |
| 1689168049 | Kacia Bundle | Nurse Practitioner | 500 W Broadway St, Missoula, MT 59802-4008 | 2018-06-19 |
| 1114424488 | Hannah Gilliland | Nurse Practitioner | 500 W Broadway St, Missoula, MT 59802-4008 | 2018-04-12 |
| 1386164408 | Sandra Lynn Cummins | Social Worker | 500 W Broadway St, Missoula, MT 59802-4008 | 2017-06-20 |
| 1548797152 | Joseph M Miller | Internal Medicine | 500 W Broadway St, Missoula, MT 59802-4008 | 2017-05-12 |
| 1083147664 | Matthew Mcgady | Physician Assistant | 500 W Broadway St, Missoula, MT 59802-4008 | 2017-04-10 |
| 1982135216 | Meeka Pradeep Gandhi | Pediatrics | 500 W Broadway St, Missoula, MT 59802-4008 | 2017-03-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945921 | Montana Endoscopy Center, Pllc | Clinic/Center | 1930 W Broadway, Ste B, Missoula, MT 59802 | 2020-06-08 |
| 1194364091 | Tommie Lynn Perusich | Nurse Practitioner | 1120 Cedar St., Missoula, MT 59802 | 2019-12-26 |
| 1386122752 | The Hope Health Alliance, Inc. | Case Management | 314 White House Ln, Missoula, MT 59802 | 2018-07-30 |
| 1881181444 | Carol Anne Lesser | Massage Therapist | 1918 Birch St, Missoula, MT 59802 | 2018-04-19 |
| 1528587581 | Missoula Aids Fund, Inc. | Clinic/Center | 1500 W. Broadway Suite A, Missoula, MT 59802 | 2017-09-11 |
| 1942740667 | Gabrielle Shulman | Counselor | 415 N Higgins Ave Ste 14, Missoula, MT 59802 | 2017-02-28 |
| 1053798736 | Endurance Physio | Clinic/Center | 214 E. Main St, Missoula, MT 59802 | 2015-05-01 |
| 1720481971 | Anna Golding | Counselor | 1325 Wyoming Street, Missoula, MONTANA 59802 | 2014-10-02 |
| 1003255803 | Jennifer Dawn Danielson | Speech-Language Pathologist | 2408 Duncan Drive, Missoula, MT 59802 | 2013-06-14 |
| 1437595725 | Partnership Health Center Inc | Clinic/Center | 1150 Sherwood St, Missoula, MT 59802 | 2013-05-14 |
| Find all providers in zip 59802 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538423207 | Earle Robert Shields | Pediatrics | 6111 Miller Creek Rd, Missoula, MT 59803-9507 | 2012-06-27 |
| 1407055130 | Christopher Jons | Pediatrics | 601 W Spruce St Ste K, Missoula, MT 59802-4047 | 2007-07-12 |
| 1942210166 | Thomas Randall | Pediatrics | 2835 Fourt Missoula Rd, Ste 205 Missoula Family Pediatrics, Missoula, MT 59804 | 2006-08-09 |
| 1750317558 | Karen Betts Mielke | Pediatrics | 500 W. Broadway St, Missoula, MT 59806-4587 | 2006-06-23 |
| 1457393357 | Lauren K Willis | Pediatrics | 2835 Fort Missoula Rd Bldg 3, Missoula, MT 59804-7423 | 2006-06-12 |
| 1841247467 | Dirk R Gottman | Pediatrics | 2835 Fort Missoula Road, Missoula, MT 59804-7408 | 2006-05-28 |
| 1023542388 | University of Utah Pediatric Services | Pediatrics | 2360 Mullan Rd, Sutie C, Missoula, MT 59808-1811 | 2017-04-13 |
| 1982135216 | Meeka Pradeep Gandhi | Pediatrics | 500 W Broadway St, Missoula, MT 59802-4008 | 2017-03-27 |
| 1043605843 | Jennifer Reck | Pediatrics | 2835 Fort Missoula Rd # 3, Missoula, MT 59804 | 2015-03-30 |
| 1568808525 | Jennifer Wilkinson | Pediatrics | 3075 N Reserve St Ste Q, Missoula, MT 59808-1390 | 2013-05-17 |
| Find all providers in MISSOULA | ||||
Please comment or provide details below to improve the information on PROVIDENCE HEALTH & SERVICES MT.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.