1972685063 NPI number — HUDSON HOLDINGS, INC.

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 1972685063 NPI number — HUDSON HOLDINGS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUDSON HOLDINGS, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1972685063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2622 W CENTRAL AVE
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67203-4969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-265-3300
Provider Business Mailing Address Fax Number:
316-265-3304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONNER SPRINGS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66012-1049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-596-0159
Provider Business Practice Location Address Fax Number:
913-596-0155
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCNAUGHT
Authorized Official First Name:
JERRI
Authorized Official Middle Name:
M
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
316-265-3300

Provider Taxonomy Codes

  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 2102475 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 210411 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100435330F , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100435330E , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2027795 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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