1922020379 NPI number — DR. JOHN W HUDSON DDS

Table of content: DR. JOHN W HUDSON DDS (NPI 1922020379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922020379 NPI number — DR. JOHN W HUDSON DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUDSON
Provider First Name:
JOHN
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUDSON
Provider Other First Name:
J
Provider Other Middle Name:
W
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1922020379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1930 ALCOA HWY
Provider Second Line Business Mailing Address:
STE 335
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37920-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-544-9021
Provider Business Mailing Address Fax Number:
865-544-9565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1930 ALCOA HWY
Provider Second Line Business Practice Location Address:
STE 335
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37920-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-544-9021
Provider Business Practice Location Address Fax Number:
865-544-9565
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  DS006030 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X , with the licence number: DS006030 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 204E00000X , with the licence number: 2901014026 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207PE0005X , with the licence number: CERTIFICATE , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083P0011X , with the licence number: CERTIFICATE , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3224723 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 199845 . This is a "CIGNA DENTAL DMO OFFC 2" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 199846 . This is a "CIGNA DENTAL DMO OFFC 3" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: DS006030 . This is a "LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 732021 . This is a "DENTAL BEN. PROV. OFFC 1" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 64777451 . This is a "KENTUCKY MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 732022 . This is a "DENTAL BEN. PROV. OFFC 2" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: TN0103 . This is a "AMERICHOICE TENNCARE O-2" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1211270 . This is a "CIGNA DENTAL DMO OFFC 1" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 199845 . This is a "CIGNA DENTAL PPO OFFC 2" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 621199959 . This is a "CIGNA DENTAL PPO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 732023 . This is a "DENTAL BEN. PROV. OFFC 3" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 0015837 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 199846 . This is a "CIGNA DENTAL PPO OFFC3" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0102 . This is a "AMERICHOICE TENNCARE O-1" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0005113 . This is a "ASSURANT EMPLOYEE BENEFIT" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: TN0104 . This is a "AMERICHOICE TENNCARE O-3" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com