Provider Demographics
NPI:1689651788
Name:RICKY SCOTT HUDSON
Entity Type:Organization
Organization Name:RICKY SCOTT HUDSON
Other - Org Name:HORIZON OSTOMY SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-980-8080
Mailing Address - Street 1:PO BOX 271456
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-1456
Mailing Address - Country:US
Mailing Address - Phone:361-980-8080
Mailing Address - Fax:361-980-8082
Practice Address - Street 1:4659 EVERHART RD
Practice Address - Street 2:SUITE 214
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2735
Practice Address - Country:US
Practice Address - Phone:361-980-8080
Practice Address - Fax:361-980-8082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0077002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX015997202Medicaid
TX087227702Medicaid
TX087227702Medicaid