| Department Of Psychiatry | |
|
901 W Jefferson St Springfield IL 62702-4833 | |
| (217) 545-8229 | |
| (217) 545-2275 |
| Full Name | Department Of Psychiatry |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 901 W Jefferson St, Springfield, Illinois |
| Authorized Official Name and Position | David J Tkach (CEO) |
| Authorized Official Contact | 2175457578 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Department Of Psychiatry Po Box 19642 Springfield IL 62794-9642 Ph: (217) 545-8229 | Department Of Psychiatry 901 W Jefferson St Springfield IL 62702-4833 Ph: (217) 545-8229 |
| NPI Number | 1558539882 |
|---|---|
| Provider Enumeration Date | 02/20/2008 |
| Last Update Date | 06/19/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558539882 | NPI | - | NPPES |
| 100066401002 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 10-0066401 (Illinois) | Primary |
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