Healthcare Provider Details

I. General information

NPI: 1750310926
Provider Name (Legal Business Name): BRIDGER ORTHOPEDICS AND SPORTS MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 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: 844-656-2480
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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JENNY FORDER
Title or Position: CFO
Credential:
Phone: 406-556-9110