Provider Demographics
NPI:1790997450
Name:CITY OF HUDSON
Entity Type:Organization
Organization Name:CITY OF HUDSON
Other - Org Name:HUDSON EMERGENCY MEDICAL SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:R
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-P
Authorized Official - Phone:330-342-1842
Mailing Address - Street 1:40 SOUTH OVIATT STREET
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-3002
Mailing Address - Country:US
Mailing Address - Phone:330-342-1842
Mailing Address - Fax:330-342-1843
Practice Address - Street 1:40 SOUTH OVIATT STREET
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-3002
Practice Address - Country:US
Practice Address - Phone:330-342-1842
Practice Address - Fax:330-342-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH77-E8503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2517904Medicaid
OH2517904Medicaid