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General NPI Number Information
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NPI Number | 1316102734
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Entity Type | Organization
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Legal Business Name | HUDSON PHYSICIANS, S.C.
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 09/11/2013
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Provider Practice Location Address
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Address Line | 2310 CRESTVIEW DR
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City | HUDSON
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State | WI
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Zip | 54016-9315
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Country | US
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Telephone | 715-531-6802
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Fax | 715-531-6803
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Provider Business Mailing Address
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Address Line | 403 STAGELINE RD
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City | HUDSON
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State | WI
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Zip | 54016-7848
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Country | US
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Telephone | 715-531-6800
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Fax | 715-531-6801
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR ADMIN
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Name | GERI T HOUSE
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Credential |
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Telephone | 715-531-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | WI
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