Basic Information
| Provider Information | |||||||||
| NPI: | 1508162702 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUDAK FAMILY MEDICINE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5187 US ROUTE 60 STE 5 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257052076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047335990 | ||||||||
| FaxNumber: | 3047335991 | ||||||||
| Practice Location | |||||||||
| Address1: | 5187 US ROUTE 60 STE 5 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257052076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047335990 | ||||||||
| FaxNumber: | 3047335991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2011 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | HUDAK | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3047335990 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 22791 | WV | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.