Basic Information
| Provider Information | |||||||||
| NPI: | 1548606775 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HUDSON PHYSICIANS S.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 STAGELINE RD | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540167848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155316800 | ||||||||
| FaxNumber: | 7155316801 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 STAGELINE RD | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540167848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155316800 | ||||||||
| FaxNumber: | 7155316801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2013 | ||||||||
| LastUpdateDate: | 05/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | WALLIN | ||||||||
| AuthorizedOfficialFirstName: | ERNIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7155316800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.