Provider Demographics
NPI:1386664381
Name:RYAN D. SCHMIDGALL, S.C.
Entity Type:Organization
Organization Name:RYAN D. SCHMIDGALL, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SCHMIDGALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-444-8447
Mailing Address - Street 1:50 VALLEY FORGE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-2372
Mailing Address - Country:US
Mailing Address - Phone:309-444-8447
Mailing Address - Fax:309-444-2003
Practice Address - Street 1:50 VALLEY FORGE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-2372
Practice Address - Country:US
Practice Address - Phone:309-444-8447
Practice Address - Fax:309-444-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI20779Medicare UPIN
ILK28558Medicare PIN
IL213776Medicare Oscar/Certification