Healthcare Provider Details

I. General information

NPI: 1902809908
Provider Name (Legal Business Name): JOHN CRAIG GILL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 HIGH COUNTRY RD BOX 115
PLAINS MT
59859-9540
US

IV. Provider business mailing address

51 HIGH COUNTRY RD BOX 115
PLAINS MT
59859-9540
US

V. Phone/Fax

Practice location:
  • Phone: 406-546-4001
  • Fax: 406-826-0017
Mailing address:
  • Phone: 406-826-0044
  • Fax: 406-826-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN24149
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: