Healthcare Provider Details

I. General information

NPI: 1992974497
Provider Name (Legal Business Name): BRIDGER CHILD & ADOLESCENT PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 HIGHLAND BLVD STE. 3340
BOZEMAN MT
59715-6911
US

IV. Provider business mailing address

931 HIGHLAND BLVD STE. 3340
BOZEMAN MT
59715-6911
US

V. Phone/Fax

Practice location:
  • Phone: 406-586-9735
  • Fax: 406-586-4713
Mailing address:
  • Phone: 406-586-9735
  • Fax: 406-586-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number8323
License Number StateMT

VIII. Authorized Official

Name: JENNIFER LYNN KROGMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 406-586-9735