1316102734 NPI number — HUDSON PHYSICIANS, S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316102734 NPI number — HUDSON PHYSICIANS, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUDSON PHYSICIANS, S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HUDSON PHYSICIANS QUICK CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316102734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 STAGELINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54016-7848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-531-6800
Provider Business Mailing Address Fax Number:
715-531-6801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2310 CRESTVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54016-9315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-531-6802
Provider Business Practice Location Address Fax Number:
715-531-6803
Provider Enumeration Date:
07/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HOUSE
Authorized Official First Name:
GERI
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CREDENTIALING COORDINATOR ADMIN
Authorized Official Telephone Number:
715-531-6060

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 32723100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000056125 . This is a "MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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