CRUSADERS CENTRAL CLINIC ASSOCIATION; NPI #1922358373

Contact Information

CRUSADERS CENTRAL CLINIC ASSOCIATION

2704 N MAIN ST
ROCKFORD, IL 61103-3112

Phone: 815-490-1600
Fax: 815-490-1845
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	`1922358373`
LBN Legal business name	CRUSADERS CENTRAL CLINIC ASSOCIATION
Authorized official	SAMUEL MILLER - (CEO/PRESIDENT)
Entity	Organization
Organization subpart ¹	Yes
Enumeration date	09/13/2012
Last updated	08/08/2023 - About 3 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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