14D0925828 CLIA NUMBER - CRUSADER CLINIC

Laboratory Demographics

  • CLIA Code: 14D0925828
  • Facility Name: CRUSADER CLINIC
  • Facility Address: 1200 W STATE STREET
    ROCKFORD, IL
    ZIP 61102
  • Facility Phone: 815 490-1600
  • Facility Type: Federally Qualified Health Center
  • Facility Type: Microscopy
  • Lab Director: GARY FERNANDO
  • NPI Number: 1780852244
  • Taxonomy: 261QF0400X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 14D0925828
LAB Type Federally Qualified Health Center
Facility Name CRUSADER CLINIC
Street 1200 W STATE STREET
City ROCKFORD
State IL
ZIP 61102
Phone 815 490-1600
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 6/1/2025
Certificate Expiration Date 5/31/2027
Facility Type Federally Qualified Health Center
Lab Director GARY FERNANDO

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This page was last updated on: 9/29/2025