Healthcare Provider Details

I. General information

NPI: 1770916827
Provider Name (Legal Business Name): HUDSON PHYSICIANS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 05/08/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 HILLCREST DR
HUDSON WI
54016-4439
US

IV. Provider business mailing address

2651 HILLCREST DR
HUDSON WI
54016-4439
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 Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CARL MATTHEW BRANDT
Title or Position: CEO
Credential:
Phone: 715-531-6800