Provider Demographics
NPI:1457487019
Name:ST. PATRICK HOSPITAL & HEALTH SCIENCES CENTER
Entity type:Organization
Organization Name:ST. PATRICK HOSPITAL & HEALTH SCIENCES CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:425-358-9786
Mailing Address - Street 1:601 W SPRUCE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4057
Mailing Address - Country:US
Mailing Address - Phone:406-728-7388
Mailing Address - Fax:406-329-2923
Practice Address - Street 1:601 W SPRUCE ST
Practice Address - Street 2:SUITE D
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4057
Practice Address - Country:US
Practice Address - Phone:406-728-7388
Practice Address - Fax:406-329-2923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTE61916Medicare UPIN