Provider Demographics
NPI:1164083531
Name:BOZEMAN SPORTS MEDICINE, INC.
Entity Type:Organization
Organization Name:BOZEMAN SPORTS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-595-3861
Mailing Address - Street 1:117 E OAK ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2977
Mailing Address - Country:US
Mailing Address - Phone:406-595-3861
Mailing Address - Fax:406-586-9708
Practice Address - Street 1:4181 FALLON ST STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4400
Practice Address - Country:US
Practice Address - Phone:406-586-2865
Practice Address - Fax:406-558-2891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty