Healthcare Provider Details

I. General information

NPI: 1679820302
Provider Name (Legal Business Name): CONFIDENCE MEDICAL ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1442 N 8TH ST SUITE C
VANDALIA IL
62471-1027
US

IV. Provider business mailing address

1442 N 8TH ST SUITE C
VANDALIA IL
62471-1027
US

V. Phone/Fax

Practice location:
  • Phone: 618-283-0266
  • Fax: 618-283-4081
Mailing address:
  • Phone: 618-283-0266
  • Fax: 618-283-4081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036086476
License Number StateIL

VIII. Authorized Official

Name: BRENT WAYNE SCHWARM
Title or Position: OWNER
Credential: MD
Phone: 618-283-0266