Basic Information
| Provider Information | |||||||||
| NPI: | 1629098355 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATTERSON | ||||||||
| FirstName: | TONI | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SMITH | ||||||||
| OtherFirstName: | TONI | ||||||||
| OtherMiddleName: | R. | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.O | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 351 CONSORT DR | ||||||||
| Address2: | |||||||||
| City: | BALLWIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630114439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362004242 | ||||||||
| FaxNumber: | 6362004243 | ||||||||
| Practice Location | |||||||||
| Address1: | 17050 BAXTER RD | ||||||||
| Address2: | DEPT. OF ANESTHESIA | ||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630051422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362004242 | ||||||||
| FaxNumber: | 6362004243 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | R1A25 | MO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 241494731 | 05 | MO | MEDICAID | 0976845 | 05 | IA | MEDICAID | 8298 | 01 | MO | HEALTHCARE USA (GROUP) | OTHER | CG4336 | 01 | RAILROAD MEDICARE | OTHER | 1909887 | 05 | IA | MEDICAID | 050055115 | 01 | RAILROAD MEDICARE | OTHER | 80171 | 01 | MO | HEALTHCARE USA | OTHER |