Provider Demographics
NPI:1902075419
Name:BRIDGER PSYCHIATRIC SERVICES PC
Entity Type:Organization
Organization Name:BRIDGER PSYCHIATRIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-586-5511
Mailing Address - Street 1:2040 N 22ND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3152
Mailing Address - Country:US
Mailing Address - Phone:406-586-5511
Mailing Address - Fax:406-586-4713
Practice Address - Street 1:2040 N 22ND AVE STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3152
Practice Address - Country:US
Practice Address - Phone:406-586-5511
Practice Address - Fax:406-586-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty