Provider Demographics
NPI:1144414269
Name:HUDSON FAMILY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:HUDSON FAMILY HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MOLESKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-655-2668
Mailing Address - Street 1:5111 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4003
Mailing Address - Country:US
Mailing Address - Phone:330-655-2668
Mailing Address - Fax:330-342-5608
Practice Address - Street 1:5111 DARROW RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4003
Practice Address - Country:US
Practice Address - Phone:330-655-2668
Practice Address - Fax:330-342-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHM1005165OtherMEDAVANT CLEARING HOUSE
OH0677389Medicaid
OHM1005165OtherMEDAVANT CLEARING HOUSE
OHF03915Medicare UPIN