Provider Demographics
NPI:1508997636
Name:ONEIL, PATRICK W (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:W
Last Name:ONEIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-1500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:54 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3050
Practice Address - Country:US
Practice Address - Phone:573-302-2287
Practice Address - Fax:573-302-2241
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000160538207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO135570020OtherMEDICARE PTAN
MO1508997636OtherNPI
MOP00780871OtherRR MEDICARE
MO245032206Medicaid
MO020010682Medicare ID - Type UnspecifiedMISSOURI FQHC MEDICARE
MOP00780871OtherRR MEDICARE