Healthcare Provider Details

I. General information

NPI: 1275761348
Provider Name (Legal Business Name): CRAIG KENNETH SWEENEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 15TH AVE S
GREAT FALLS MT
59405-5240
US

IV. Provider business mailing address

3000 15TH AVE S
GREAT FALLS MT
59405-5240
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-2171
  • Fax:
Mailing address:
  • Phone: 406-454-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number32777
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number32777
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: