Healthcare Provider Details

I. General information

NPI: 1407228265
Provider Name (Legal Business Name): BRIDGER ORTHOPEDIC WALK IN CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 01/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 LARAMIE DR
BOZEMAN MT
59718-2005
US

IV. Provider business mailing address

1450 ELLIS ST SUITE 201
BOZEMAN MT
59715-8812
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-0122
  • Fax: 406-587-5548
Mailing address:
  • Phone: 406-587-0122
  • Fax: 406-587-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: LISA K STRICKLER
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 406-522-1144