1750310926 NPI number — BRIDGER ORTHOPEDICS AND SPORTS MEDICINE, PC

Table of Contents

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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