Provider Demographics
NPI:1750310926
Name:BRIDGER ORTHOPEDICS AND SPORTS MEDICINE, PC
Entity Type:Organization
Organization Name:BRIDGER ORTHOPEDICS AND SPORTS MEDICINE, PC
Other - Org Name:BRIDGER ORTHOPEDIC AND SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:FORDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-556-9110
Mailing Address - Street 1:1450 ELLIS ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8812
Mailing Address - Country:US
Mailing Address - Phone:406-587-0122
Mailing Address - Fax:406-587-5548
Practice Address - Street 1:3400 LARAMIE DR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2005
Practice Address - Country:US
Practice Address - Phone:406-587-0122
Practice Address - Fax:844-656-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1253520001Medicare NSC
MT000080269Medicare PIN