CRUSADERS CENTRAL CLINIC ASSOCIATION NPI 1265601488

NPI Information

NPI: 1265601488
Provider Name: CRUSADERS CENTRAL CLINIC ASSOCIATION
Classification: Clinic/Center - 261QF0400X
Specialization: Federally Qualified Health Center (FQHC)
Entity Type: Organization
Doing Business As: CRUSADER CLINIC BROADWAY
CLIA Number: 14D2133501
Address: 1100 BROADWAY
ROCKFORD, IL
ZIP 61104
Phone: (815) 490-1601

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NPI Details

CRUSADERS CENTRAL CLINIC ASSOCIATION is a federally qualified health center (fqhc) clinic center in Rockford, IL. CRUSADERS CENTRAL CLINIC ASSOCIATION NPI is 1265601488. The provider is registered as an organization entity type.
The provider Is Doing Business As Crusader Clinic Broadway.

The provider's business location address is:

1100 BROADWAY
ROCKFORD, IL
ZIP 61104-429
Phone: (815) 490-1601
Fax: (815) 490-1625

The provider's authorized official is Samuel Miller .
The authorized official title is President & Ceo and has the following contact phone number (815) 490-1737.

The CLIA number assigned to this NPI record is 14D2133501 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/21/2008 and was last updated on 8/24/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier Issuer
1	103436	OTHER	DORAL
2	027548	OTHER	CHAMPUS
3	1011514778	OTHER	BLUE CROSS BLUE SHIELD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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