Healthcare Provider Details

I. General information

NPI: 1073437679
Provider Name (Legal Business Name): HUDSON PHYSICIANS, S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 MEMORIAL AVE N STE 200
STILLWATER MN
55082-1093
US

IV. Provider business mailing address

5715 MEMORIAL AVE N STE 200
STILLWATER MN
55082-1093
US

V. Phone/Fax

Practice location:
  • Phone: 715-531-6800
  • Fax: 715-531-6801
Mailing address:
  • Phone: 715-531-6800
  • Fax: 715-531-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MARK D STANNARD
Title or Position: SHAREHOLDER
Credential: M.D.
Phone: 715-531-6800