Healthcare Provider Details

I. General information

NPI: 1164083531
Provider Name (Legal Business Name): BOZEMAN SPORTS MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4181 FALLON ST STE 2
BOZEMAN MT
59718-4400
US

IV. Provider business mailing address

117 E OAK ST STE 1A
BOZEMAN MT
59715-2977
US

V. Phone/Fax

Practice location:
  • Phone: 406-586-2865
  • Fax: 406-558-2891
Mailing address:
  • Phone: 406-595-3861
  • Fax: 406-586-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIK STUART ADAMS
Title or Position: PRESIDENT
Credential: MD
Phone: 406-595-3861