Provider Demographics
NPI:1326551938
Name:HUDSON FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:HUDSON FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-384-2617
Mailing Address - Street 1:6031 BLAIR CIR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-7064
Mailing Address - Country:US
Mailing Address - Phone:850-384-2617
Mailing Address - Fax:
Practice Address - Street 1:1766 SEA LARK LN UNIT 2
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-7472
Practice Address - Country:US
Practice Address - Phone:850-226-6803
Practice Address - Fax:888-224-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care