Provider Demographics
NPI:1083757918
Name:JANE K HUDSON MD PC
Entity Type:Organization
Organization Name:JANE K HUDSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-373-4340
Mailing Address - Street 1:3400 NW EXPRESSWAY ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4493
Mailing Address - Country:US
Mailing Address - Phone:405-945-4538
Mailing Address - Fax:405-373-2950
Practice Address - Street 1:3400 NW EXPRESSWAY ST
Practice Address - Street 2:SUITE 410
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4493
Practice Address - Country:US
Practice Address - Phone:405-945-4538
Practice Address - Fax:405-373-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19478207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG93448Medicare UPIN