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PROVIDENCE ST JOSEPH MEDICAL CENTER
NPI 1285796920
Assisted Living Facility in Polson, MT

Active since December 15, 2006CLIA 27D0411066 · Microscopy
11 17TH AVE E, POLSON, MT 59860(406) 883-1011 Get Directions Write a Review

NPPES record last updated: April 5, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Providence St Joseph Medical Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE ST JOSEPH MEDICAL CENTER (NPI 1285796920), doing business as Prov St Joseph Med Ctr Rc, is a healthcare organization registered as an assisted living facility in Polson, Montana and active in the NPI registry since December 2006. The organization holds a CLIA Microscopy certificate valid through June 14, 2028 and lists Donald Wayne Anderson, Assistant Secretary Enrollments, as its authorized official.

NPPES Registry Identity

NPI1285796920
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NamePROVIDENCE ST JOSEPH MEDICAL CENTER
Location Address11 17TH AVE EPolson, MT 59860-4083
Mailing AddressPo Box 31001-4110Pasadena, CA 91110-4110 · (406) 883-1011
Phone(406) 883-1011
Organization SubpartYesParent: Providence Health & Services
Authorized OfficialDonald Wayne AndersonAssistant Secretary Enrollments · (425) 358-9786
Enumeration DateDecember 15, 2006
Last NPPES UpdateApril 5, 2025
NPPES CertifiedApril 5, 2025
✔ NPI 1285796920 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
License✔ Licensed in MT · 10123
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
11 17TH AVE E, Polson, MT 59860
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Other Names 1

Doing Business AsProv St Joseph Med Ctr Rc

Other Identifiers 1

Medicaid810628MT

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 27D0411066

Providence St Joseph Medical Center Polson Rhc · Polson, MT
Active · expires Jun 14, 2028
CLIA Number27D0411066
Laboratory TypeRural Health Clinic
Certificate Effective DateJune 15, 2026
Certificate Expiration DateJune 14, 2028
Laboratory DirectorDr. Kelly G. Bagnell
Laboratory Phone(406) 883-8913
Laboratory LocationProvidence St Joseph Medical Center Polson Rhc6 - 13th Avenue East, Polson, MT 59860
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence St Joseph Medical Center's NPI number?

The NPI number for Providence St Joseph Medical Center is 1285796920. It was assigned to this organization in the NPPES registry on December 15, 2006. The provider is doing business as Prov St Joseph Med Ctr RC.

Where is Providence St Joseph Medical Center located?

Providence St Joseph Medical Center is located at 11 17th Ave E, Polson, MT 59860. The listed phone number is (406) 883-1011.

What is Providence St Joseph Medical Center's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Providence St Joseph Medical Center hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 27D0411066) is associated with this NPI, valid through June 14, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Providence St Joseph Medical Center was last updated on April 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.