| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 403 Stageline Rd, Hudson, Wisconsin |
| Authorized Official Name and Position | Douglas Johnson (CFO) |
| Authorized Official Contact | 7155316013 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
403 Stageline Rd Hudson WI 54016 Ph: (715) 531-6800 | 403 Stageline Rd Hudson WI 54016 Ph: (715) 531-6800 |
| NPI Number | 1184685190 |
|---|---|
| Provider Enumeration Date | 03/29/2006 |
| Last Update Date | 10/20/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184685190 | NPI | - | NPPES |
| 00485 | Other | WI | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Promed Preferred Wi Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 155 2nd St S, Hudson, WI 54016 Phone: 615-499-3165 | |
Fairview Express Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2651 Hillcrest Dr Ste 302, Hudson, WI 54016 Phone: 612-365-5000 | |
Hudson Physicians S.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 403 Stageline Rd, Hudson, WI 54016 Phone: 715-531-6800 Fax: 715-531-6801 |