Provider Demographics
NPI:1922253079
Name:HUDSON PRIMARY CARE PA
Entity Type:Organization
Organization Name:HUDSON PRIMARY CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCBURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-728-0900
Mailing Address - Street 1:270 PINE MOUNTAIN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HUDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28638-2634
Mailing Address - Country:US
Mailing Address - Phone:828-728-0900
Mailing Address - Fax:828-728-0868
Practice Address - Street 1:895 STATE FARM RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4917
Practice Address - Country:US
Practice Address - Phone:828-268-1100
Practice Address - Fax:828-728-0868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39973261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903060Medicaid
NC5903060Medicaid