| NPI | 1558407312 |
|---|---|
| Doing Business As | PMG MT LIFESPAN FAMILY MED |
| Doing Business As | PROVIDENCE MEDICAL GROUP MONTANA |
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary Enrollments 425-358-9786 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NA) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2025-05-07 |