MEDICARE: CITY OF HUDSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	77-E850	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790997450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF HUDSON

Provider Business Mailing Address
First Line	:	40 SOUTH OVIATT STREET
Second Line	:
City	:	HUDSON
State	:	OH
Zip	:	44236-3002
Country	:	US
Telephone Number	:	330-342-1842
Fax Number	:	330-342-1843

Provider Business Practice Location Address
First Line	:	40 SOUTH OVIATT STREET
Second Line	:
City	:	HUDSON
State	:	OH
Zip	:	44236-3002
Country	:	US
Telephone Number	:	330-342-1842
Fax Number	:	330-342-1843

Authorized Official
Title or Position	:	EMS DIRECTOR
Name	:	MR. R BRUCE GRAHAM
Credential	:	NREMT-P
Telephone Number	:	330-342-1842

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/22/2020

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Directions to “CITY OF HUDSON ” Practice Location

Language	Start Address	Practice Location

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