Psychiatric Associates of Rockford SC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

PSYCHIATRIC ASSOCIATES OF ROCKFORD SC

Practice address

6078 Palo Verde Dr
Rockford, IL 61114-8117

Phone

(815) 398-9360

Fax

(815) 398-1028

NPI assigned

Dec 12, 2006

Last updated

Dec 6, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Peter Smith

Title

Credentialing Manager

Phone

(815) 965-8505

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323129600000",
    "number": "1013077619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6078 PALO VERDE DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148117",
            "telephone_number": "815-398-9360",
            "fax_number": "815-398-1028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6078 PALO VERDE DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611148117",
            "telephone_number": "815-398-9360",
            "fax_number": "815-398-1028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCHIATRIC ASSOCIATES OF ROCKFORD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2011-12-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "815-965-8505"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Provenza
• Ian Victor Provo
• Landon S Pryor, M.D.
• Daniel Psaltis, DC
• Nick D Psaltis, D.C.
• Psychiatric Clinics of Northern Illinois PC
• Pumilia Family Dental LLC
• Pacita Marie Pumilia, B.S.D.D.S.
• Michael Puruckherr, MD
• Denise Purvis, LCPC

• Psychiatry Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Psychiatry Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.