Basic Information
| Provider Information | |||||||||
| NPI: | 1679820302 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONFIDENCE MEDICAL ASSOCIATES, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1442 N 8TH ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | VANDALIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624711027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182830266 | ||||||||
| FaxNumber: | 6182834081 | ||||||||
| Practice Location | |||||||||
| Address1: | 1442 N 8TH ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | VANDALIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624711027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182830266 | ||||||||
| FaxNumber: | 6182834081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2012 | ||||||||
| LastUpdateDate: | 08/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | SCHWARM | ||||||||
| AuthorizedOfficialFirstName: | BRENT | ||||||||
| AuthorizedOfficialMiddleName: | WAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6182830266 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CONFIDENCE MEDICAL ASSOCIATES, LTD. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036086476 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.