Provider Demographics
NPI:1144619750
Name:ROCKFORD PSYCHIATRIC MEDICAL SERVICES SC
Entity Type:Organization
Organization Name:ROCKFORD PSYCHIATRIC MEDICAL SERVICES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GIAKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-395-1500
Mailing Address - Street 1:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61105-0957
Mailing Address - Country:US
Mailing Address - Phone:815-654-7772
Mailing Address - Fax:815-654-7009
Practice Address - Street 1:1639 N ALPINE RD
Practice Address - Street 2:260
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1449
Practice Address - Country:US
Practice Address - Phone:815-395-1500
Practice Address - Fax:815-395-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012268363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty