MEDICARE: ROCKFORD PSYCHIATRIC MEDICAL SERVICES, S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036083961	IL

General Provider Information

NPI Number	:	1821391442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKFORD PSYCHIATRIC MEDICAL SERVICES, S.C.

Provider Business Mailing Address
First Line	:	1639 N ALPINE RD STE 260
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-1481
Country	:	US
Telephone Number	:	630-912-4241
Fax Number	:

Provider Business Practice Location Address
First Line	:	1639 N ALPINE RD STE 260
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-1481
Country	:	US
Telephone Number	:	815-395-1500
Fax Number	:	815-395-1415

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	BRANDY L MARRINER
Credential	:
Telephone Number	:	630-912-4241

Provider Enumeration Date	:	12/21/2010
Last Update Date	:	04/09/2026

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