Provider Demographics
NPI:1972616514
Name:ROCFKFORD PSYCHIATRIC MEDICAL SERVICES
Entity Type:Organization
Organization Name:ROCFKFORD PSYCHIATRIC MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:1639 N ALPINE RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1449
Mailing Address - Country:US
Mailing Address - Phone:815-395-1500
Mailing Address - Fax:815-395-1415
Practice Address - Street 1:1639 N ALPINE RD
Practice Address - Street 2:SUITE 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:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209532Medicare ID - Type Unspecified