CRUSADERS CENTRAL CLINIC ASSOCIATION; NPI #1417203191

Contact Information

CRUSADERS CENTRAL CLINIC ASSOCIATION

1200 W STATE ST
ROCKFORD, IL 61102-2112

Phone: 815-490-1600
Fax: 815-490-1625
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Federally Qualified Health Center (FQHC)	261QF0400X	B4[14]	Federally Qualified Health Center

Indicates primary specialty

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NPI Profile & details for CRUSADERS CENTRAL CLINIC ASSOCIATION

NPI Number	`1417203191`
LBN Legal business name	CRUSADERS CENTRAL CLINIC ASSOCIATION
Authorized official	SAMUEL MILLER - (PRESIDENT AND CEO)
Entity	Organization
Organization subpart ¹	Yes
Enumeration date	07/31/2012
Last updated	02/25/2022 - About 4 years ago
Identifiers	n/a

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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