Provider Demographics
NPI:1376620419
Name:HUDSON'S MEDICINE CHEST
Entity Type:Organization
Organization Name:HUDSON'S MEDICINE CHEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-332-0203
Mailing Address - Street 1:500 N MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4670
Mailing Address - Country:US
Mailing Address - Phone:580-332-0203
Mailing Address - Fax:580-332-3228
Practice Address - Street 1:500 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4670
Practice Address - Country:US
Practice Address - Phone:580-332-0203
Practice Address - Fax:580-332-3228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0566750001Medicare ID - Type UnspecifiedMEDICARE