MEDICARE: BOZEMAN SPORTS MEDICINE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1164083531
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOZEMAN SPORTS MEDICINE, INC.

Provider Business Mailing Address
First Line	:	117 E OAK ST STE 1A
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59715-2977
Country	:	US
Telephone Number	:	406-595-3861
Fax Number	:	406-586-9708

Provider Business Practice Location Address
First Line	:	4181 FALLON ST STE 2
Second Line	:
City	:	BOZEMAN
State	:	MT
Zip	:	59718-4400
Country	:	US
Telephone Number	:	406-586-2865
Fax Number	:	406-558-2891

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERIK STUART ADAMS
Credential	:	MD
Telephone Number	:	406-595-3861

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	09/28/2021

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