Provider Demographics
NPI:1366493215
Name:CITY OF HUDSON
Entity Type:Organization
Organization Name:CITY OF HUDSON
Other - Org Name:CITY OF HUDSON - ST. CROIX EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-386-4777
Mailing Address - Street 1:505 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 3RD ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1603
Practice Address - Country:US
Practice Address - Phone:715-386-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0714881Medicaid
WI0100OtherJOHN DEERE
1012558OtherPHYSICIAN'S PLUS
41341900OtherHIRSP
WI41341900Medicaid
601746300OtherWORKER'S COMP
8180016OtherMEDICA MAHMO
000088478OtherADVOCARE MCHMO
MN623567100Medicaid
IL=========001Medicaid
1012558OtherPHYSICIAN'S PLUS
=========014OtherVALLEY HEALTH PLAN
WI0100OtherJOHN DEERE
000088478Medicare ID - Type UnspecifiedMEDICARE