Healthcare Provider Details

I. General information

NPI: 1952476335
Provider Name (Legal Business Name): GREGORY HUDSON MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 STATE ROUTE 3117
SOUTH SHORE KY
41175
US

IV. Provider business mailing address

137 STATE ROUTE 3117
SOUTH SHORE KY
41175
US

V. Phone/Fax

Practice location:
  • Phone: 606-932-2079
  • Fax: 606-932-2313
Mailing address:
  • Phone: 606-932-2079
  • Fax: 606-932-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE HUNT
Title or Position: BILLING CREDENTIALING
Credential:
Phone: 606-932-2079