Provider Demographics
NPI:1922087576
Name:MEDICAL PSYCHIATRY SERVICES LLC
Entity Type:Organization
Organization Name:MEDICAL PSYCHIATRY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINTFORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-757-1337
Mailing Address - Street 1:4350 7TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6870
Mailing Address - Country:US
Mailing Address - Phone:309-757-1337
Mailing Address - Fax:309-757-1339
Practice Address - Street 1:4350 7TH ST STE D
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6870
Practice Address - Country:US
Practice Address - Phone:309-757-1337
Practice Address - Fax:309-757-1339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361059332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105933Medicaid
IL212446Medicare PIN
IL036105933Medicaid