CRUSADERS CENTRAL CLINIC ASSOCIATION


Address: 1200 W State St, Rockford, IL 61102-2112
Phone: 8154901601

CRUSADERS CENTRAL CLINIC ASSOCIATION (NPI# 1902972557) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1902972557
Entity Type Organization
Organization Name CRUSADERS CENTRAL CLINIC ASSOCIATION
Practice Address 1200 W State St
Rockford
IL 61102-2112
Practice Telephone 8154901601
Mailing Telephone 8154901600
Mailing Fax Number 8154901845
Enumeration Date 2006-11-27
Last Update Date 2019-03-19
Authorized Official Name SAMUEL MILLER (CFO)
Authorized Official Telephone 8154901737
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QF0400X Clinic/Center
Specialization: Federally Qualified Health Center (FQHC)
Ambulatory Health Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
IL DORAL 101319 01
CHAMPUS 027548 01
BLUE CROSS BLUE SHIELD 101-15147-78 01

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1205238623 Crusaders Central Clinic Association Clinic/Center 1002 N Pierpont Ave, Rockford, IL 61101 2014-09-17
1891082194 Crusaders Central Clinic Association Clinic/Center 6115 N 2nd St, Loves Park, IL 61111-4155 2011-07-07
1780852244 Crusaders Central Clinic Association Clinic/Center 1050 Logan Ave, Belvidere, IL 61008-3966 2008-02-18
1164999892 Crusaders Central Clinic Association Case Management 1200 W State St, Rockford, IL 61102-2112 2018-10-31
1346762390 Crusaders Central Clinic Association Clinic/Center 840 Blackhawk Blvd, South Beloit, IL 61080-2263 2017-07-12
1811419245 Crusaders Central Clinic Association Clinic/Center 245 Prairie Hill Rd, South Beloit, IL 61080-2579 2017-07-07
1508306861 Crusaders Central Clinic Association Clinic/Center 1215 N Alpine Rd, Rockford, IL 61107-2201 2017-03-06
1922358373 Crusaders Central Clinic Association Clinic/Center 2704 N Main St, Rockford, IL 61103-3112 2012-09-13
1417203191 Crusaders Central Clinic Association Clinic/Center 1200 W State St, Rockford, IL 61102-2112 2012-07-31
1265601488 Crusaders Central Clinic Association Clinic/Center 1100 Broadway, Rockford, IL 61104-1429 2008-02-21

Office Location

Street Address 1200 W STATE ST
City ROCKFORD
State IL
Zip Code 61102-2112

Providers in the same location

NPI Name Taxonomy Address Enumeration
1780680827 Barbara B Morgan Nurse Practitioner 1200 W State St, Rockford, IL 61102-2112 2005-06-23
1588271894 Angela Siebold Nurse Practitioner 1200 W State St, Rockford, IL 61102-2112 2020-09-30
1942814322 Jacqueline Paige Cabrera Nurse Practitioner 1200 W State St, Rockford, IL 61102-2112 2020-09-03
1285250951 Aaleeyah Pringle Alim Dentist 1200 W State St, Rockford, IL 61102-2112 2020-06-18
1639792419 Jessica Lauren Cole Physician Assistant 1200 W State St, Rockford, IL 61102-2112 2020-05-27
1437779071 Christian Murillo Physician Assistant 1200 W State St, Rockford, IL 61102-2112 2020-04-23
1033746573 Erin Ashleigh Donahue Physician Assistant 1200 W State St, Rockford, IL 61102-2112 2020-03-25
1609406008 Marissa Dreger Family Medicine 1200 W State St, Rockford, IL 61102-2112 2020-01-24
1962041657 Sabrina Lee Puvalowski Physician Assistant 1200 W State St, Rockford, IL 61102-2112 2019-12-30
1932741717 Jacob Dalton Boehm Physician Assistant 1200 W State St, Rockford, IL 61102-2112 2019-10-12
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1205115383 Renee Lynn Keeney Advanced Practice Midwife 1200 W. State Street, Crusader Community Health, Rockford, IL 61102 2011-08-08
1689895906 Linda Lou O'reilly Local Education Agency (LEA) 1515 S. Meridian Road, Rockford, IL 61102 2007-05-02
1801012992 Jennifer Anne Boyd Developmental Therapist Nia 1515 S. Meridian Rd., Rockford, IL 61102 2007-04-17
1609173434 Kellie J Gibbons Registered Nurse 650 W State Street, Winnebago County Jail Medical Unit, Rockford, IL 61102-0000 2011-02-14
1275708752 Mercy Ambulance Service LLC Ambulance 1025 Campton Dr, Rockford, IL 61102-1066 2008-04-25
1417448424 Brittany Nicole Lambert Student in an Organized Health Care Education/Training Program 8040 Towermont Dr, Rockford, IL 61102-1080 2018-05-24
1164490132 Harlan Johnson Counselor 852 Lakewood Dr, Rockford, IL 61102-1228 2006-03-08
1184137283 Gail Mary Swenson Speech-Language Pathologist 730 Lincoln Park Blvd, Rockford, IL 61102-1429 2017-11-10
1659316339 Institute of Family Care Home Health 417 S Pierpont Ave, Rockford, IL 61102-1656 2006-06-18
1861851438 Walgreen Co Durable Medical Equipment & Medical Supplies 1200 W State St Ste 102, Rockford, IL 61102-2112 2016-02-11
Find all providers in zip 61102

Taxonomy Information

Taxonomy Code 261QF0400X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Federally Qualified Health Center (FQHC)

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1205238623 Crusaders Central Clinic Association Clinic/Center 1002 N Pierpont Ave, Rockford, IL 61101 2014-09-17
1306486022 The Board of Trustees of The University of Illinois Clinic/Center 1221 E State St, Rockford, IL 61104-2231 2020-01-10
1295386308 Altapointe Health Systems, Inc. Clinic/Center 9518 Us Highway 231, Rockford, AL 35136-5214 2019-09-20
1043746720 Aunt Martha's Health and Wellness Clinic/Center 1401 E State St, Suite 3000, Rockford, IL 61104-2315 2017-05-02
1508306861 Crusaders Central Clinic Association Clinic/Center 1215 N Alpine Rd, Rockford, IL 61107-2201 2017-03-06
1922358373 Crusaders Central Clinic Association Clinic/Center 2704 N Main St, Rockford, IL 61103-3112 2012-09-13
1417203191 Crusaders Central Clinic Association Clinic/Center 1200 W State St, Rockford, IL 61102-2112 2012-07-31
1265601488 Crusaders Central Clinic Association Clinic/Center 1100 Broadway, Rockford, IL 61104-1429 2008-02-21
1073782298 Crusaders Central Clinic Association Clinic/Center 1200 W State St, Rockford, IL 61102-2112 2008-02-21
1437328655 Crusaders Central Clinic Association Clinic/Center 1720 18th Ave, Rockford, IL 61104-7352 2008-02-21
Find all providers in ROCKFORD

Competitor

Search similar providers

City ROCKFORD
Zip Code 61102

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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