1982874442 NPI number — CHARLES F. HUDSON

Table of content: (NPI 1982874442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982874442 NPI number — CHARLES F. HUDSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES F. HUDSON
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:
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:
1982874442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3002 MANATEE AVE W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34205-4241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-746-4531
Provider Business Mailing Address Fax Number:
941-745-2046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3002 MANATEE AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34205-4241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-746-4531
Provider Business Practice Location Address Fax Number:
941-745-2046
Provider Enumeration Date:
03/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HUDSON
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
F
Authorized Official Title or Position:
DOCTOR/MANAGER
Authorized Official Telephone Number:
941-746-4531

Provider Taxonomy Codes

  • Taxonomy code: 111NI0013X , with the licence number:  CH1291 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: K2529 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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