Healthcare Provider Details

I. General information

NPI: 1336292416
Provider Name (Legal Business Name): FAMILY MEDICINE ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 VANDALIA ST SUITE 100
COLLINSVILLE IL
62234-4061
US

IV. Provider business mailing address

531 VANDALIA ST SUITE 100
COLLINSVILLE IL
62234-4061
US

V. Phone/Fax

Practice location:
  • Phone: 618-344-0090
  • Fax: 618-344-4371
Mailing address:
  • Phone: 618-344-0090
  • Fax: 618-344-4371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. PATRICK S ZIMMERMANN
Title or Position: PRESIDENT
Credential: MD
Phone: 618-344-0090