Provider Demographics
NPI:1407052616
Name:ROBERT L SWEETEN MD INC
Entity Type:Organization
Organization Name:ROBERT L SWEETEN MD INC
Other - Org Name:SWEETEN MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:SWEETEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-540-6798
Mailing Address - Street 1:PO BOX 4725
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-4725
Mailing Address - Country:US
Mailing Address - Phone:417-451-7425
Mailing Address - Fax:417-451-7455
Practice Address - Street 1:1355 ROCKETDYNE RD
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-3106
Practice Address - Country:US
Practice Address - Phone:417-451-7425
Practice Address - Fax:417-451-7455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12749207R00000X
MO2007032918207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015453OtherMEDICARE PTAN
OKD35332Medicare UPIN
OKD35332Medicare UPIN