PROVIDENCE HEALTH & SERVICES MT (NPI# 1326483587) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326483587 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH & SERVICES MT |
| Other Organization Name | MONTANA CANCER CENTER AT PROVIDENCE ST. PATRICK HOSPITAL |
| Practice Address |
24001 East Mission Ave. Ste 105 Providence Healtlh and Services, Montana Liberty Lake WA 99019-0012 |
| Mailing Address |
500 W Broadway St Montana Cancer Center At Providence Saint Patrick Hosp Missoula MT 59802-4008 |
| Practice Telephone | 4063271918 |
| Mailing Telephone | 4067282539 |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2013-05-09 |
| Authorized Official Name | TERI MASTERS (MANAGER) |
| Authorized Official Telephone | 4065437271 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE HEALTH & SERVICES MT |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
13200 | MT | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Montana Cancer Center at Providence St. Patrick Hospital | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1598064628 | Providence Health & Services Mt | Clinic/Center | 601 W Spruce St, Suite A, Missoula, MT 59802-4057 | 2011-03-15 |
| Street Address |
24001 EAST MISSION AVE. STE 105 PROVIDENCE HEALTLH AND SERVICES, MONTANA |
| City | LIBERTY LAKE |
| State | WA |
| Zip Code | 99019-0012 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194201533 | Lorena Margaret De La Rosa | Nurse Practitioner | 22820 E Appleway Ave Ste A, Liberty Lake, WA 99019 | 2018-07-18 |
| 1831641570 | Shirla Underwood | Spec/Tech, Cardiovascular | 3705 S Molter Rd, Liberty Lake, WA 99019 | 2016-10-28 |
| 1215393079 | Samuel Lionel Nelson | Chiropractor | 23801 East Appleway Ave, #110, Liberty Lake, WA 99019 | 2016-01-11 |
| 1841627601 | Noland Peterdy | Pharmacist | 1423 N Molter 727, Liberty Lake, WA 99019 | 2013-10-10 |
| 1043559446 | Phillip Wayne Harris | Reflexologist | E 23505 Appleway, Liberty Lake, WA 99019 | 2013-02-05 |
| 1710231766 | Mark Autrey | Pharmacist | 23010 E Settler Drive, Spokane, WA 99019 | 2012-10-30 |
| 1982971107 | Michele Ladd | Dental Hygienist | 22826 East Clearwater Lane, Liberty Lake, WA 99019 | 2011-11-17 |
| 1467689166 | Drostan Gregg Baker | Family Medicine | 2207 N Molter Rd Ste 203, Liberty Lake, WA 99019 | 2009-06-19 |
| 1619117959 | Joline Marie Messina | Behavioral Analyst | 1324 N Liberty Lake Rd # 193, Liberty Lake, WA 99019 | 2009-02-26 |
| 1144427964 | J. Evans, Dmd, P.s. | Dentist | 1327 N Stanford Lane, Suite B, Liberty Lake, WA 99019 | 2007-06-27 |
| Find all providers in zip 99019 | ||||
| Taxonomy Code | 207RX0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Medical Oncology |
| An internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers therapy for these malignancies as well as consults with surgeons and radiotherapists on other treatments for cancer. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source. 11/5/2007: corrected definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285286369 | Candice Mccoy | Internal Medicine | 400 Dexter Ave N Ste 1200, Seattle, WA 98109-5094 | 2019-07-10 |
| 1265860027 | Vista Oncology Inc Ps | Internal Medicine | 420 Mcphee Rd Se, Olympia, WA 98502 | 2013-10-14 |
| 1295000552 | Jesse Johnston Salk | Internal Medicine | 1660 S Columbian Way # S-111onc, Seattle, WA 98108-1532 | 2012-03-19 |
| 1962777862 | Charles M Bagley Jr. | Internal Medicine | 1235 8th Ave W, Seattle, WA 98119-3441 | 2012-03-12 |
| 1548556384 | Janghee Woo | Internal Medicine | 825 Eastlake Ave. East, Seattle, WA 98109 | 2011-06-20 |
| 1174849855 | B Chue Consulting, P.s. | Internal Medicine | 2825 Eastlake Ave E Ste 200, Seattle, WA 98102-3085 | 2010-04-20 |
| 1740449602 | Kinsey A Mccormick | Internal Medicine | 1221 Madison St Ste 500, Seattle, WA 98104-1388 | 2008-06-05 |
| 1336310028 | Brian Wayne Goodell | Internal Medicine | 24705 142nd Ave Se, Kent, WA 98042-5152 | 2008-03-20 |
| 1003009259 | Providence Health & Service - Washington | Internal Medicine | 2015 Cooks Hill Rd, Suite 200, Centralia, WA 98531-9074 | 2007-08-21 |
| 1356562250 | Martin Alexander Cheever | Internal Medicine | 825 Eastlake Ave E # G4-610, Seattle, WA 98109-4405 | 2007-05-01 |
| Find all providers with the same taxonomy | ||||
| City | LIBERTY LAKE |
| Zip Code | 99019 |
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| 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.