Provider Demographics
NPI:1407837735
Name:PIONTEK, THOMAS R (CRNA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:PIONTEK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:THOMAS
Other - Middle Name:R
Other - Last Name:PIONTEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 502852
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-2852
Mailing Address - Country:US
Mailing Address - Phone:314-364-4200
Mailing Address - Fax:
Practice Address - Street 1:901 E 5TH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3127
Practice Address - Country:US
Practice Address - Phone:636-239-8301
Practice Address - Fax:636-390-7387
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN070195163W00000X
MO070195367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO912832730Medicaid
MO040060244Medicare ID - Type Unspecified