Provider Demographics
NPI:1821391442
Name:ROCKFORD PSYCHIATRIC MEDICAL SERVICES, S.C.
Entity type:Organization
Organization Name:ROCKFORD PSYCHIATRIC MEDICAL SERVICES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARRINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-912-4241
Mailing Address - Street 1:1639 N ALPINE RD STE 260
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1481
Mailing Address - Country:US
Mailing Address - Phone:630-912-4241
Mailing Address - Fax:
Practice Address - Street 1:1639 N ALPINE RD STE 260
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1481
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:2010-12-21
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360839612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty