Organization · Type 2 NPI

Providence Health & Services MT

Obstetrics & Gynecology Physician · Missoula, MT

NPI number 1417198243 Active

Practice location

1211 S Reserve St Ste 101
Missoula, MT 59801-3103

Call (406) 327-3057 Map

Fax (406) 327-3231

Mailing address

PO Box 31001-4114
Pasadena, CA 91110-4114

Specialties and licenses

Taxonomy	Code	License
Obstetrics & Gynecology Physician Primary	207V00000X	None listed

Obstetrics & Gynecology Physician: An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

7 other providers at this address

Other obstetrics & gynecology physician providers in Missoula

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NPI record

NPI: 1417198243
Entity type: Organization (Type 2)
Issued: Mar 6, 2009
Last updated: Sep 16, 2026
Status: Active
Subpart: Yes of Providence Health & Services

Other names

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PMG MT Women's Care Center · doing business as
PMG MT Women's Care Center · doing business as
Providence Medical Group Montana · doing business as

Authorized official

Donald Wayne Anderson
Assistant Secretary Enrollments
(425) 358-9786

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1417198243

Providence Health & Services MT's National Provider Identifier is 1417198243, issued on Mar 6, 2009. The primary taxonomy on file is Obstetrics & Gynecology Physician (207V00000X), and the practice location is in Missoula, MT. The record was last updated on Sep 16, 2026.