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General NPI Number Information
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NPI Number | 1063553980
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Entity Type | Organization
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Legal Business Name | HUDSON FAMILY PRACTICE, INC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 5655 HUDSON DR SUITE 303
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City | HUDSON
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State | OH
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Zip | 44236
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Country | US
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Telephone | 330-800-4800
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Fax | 330-653-3007
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Provider Business Mailing Address
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Address Line | 5655 HUDSON DR SUITE 303
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City | HUDSON
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State | OH
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Zip | 44236
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Country | US
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Telephone | 330-800-4800
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Fax | 330-653-3007
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERRY JOHN WAGNER
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Credential | D.O.
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Telephone | 330-344-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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