Healthcare Provider Details

I. General information

NPI: 1609184597
Provider Name (Legal Business Name): HUDSON HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 JENNIFER RAE JUNCTION NORTH
ROBERTS WI
54023-8639
US

IV. Provider business mailing address

405 STAGELINE RD
HUDSON WI
54016-7848
US

V. Phone/Fax

Practice location:
  • Phone: 715-531-6000
  • Fax:
Mailing address:
  • Phone: 715-531-6000
  • Fax: 715-531-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS JOHNSON
Title or Position: CFO
Credential:
Phone: 715-531-6013