1750310926 NPI number — BRIDGER ORTHOPEDICS AND SPORTS MEDICINE, PC

Table of content: (NPI 1750310926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750310926 NPI number — BRIDGER ORTHOPEDICS AND SPORTS MEDICINE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIDGER ORTHOPEDICS AND SPORTS MEDICINE, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRIDGER ORTHOPEDIC AND SPORTS MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750310926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1450 ELLIS ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
BOZEMAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59715-8812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-587-0122
Provider Business Mailing Address Fax Number:
406-587-5548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 LARAMIE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOZEMAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59718-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-587-0122
Provider Business Practice Location Address Fax Number:
844-656-2480
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FORDER
Authorized Official First Name:
JENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
406-556-9110

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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