Provider Demographics
NPI:1952476335
Name:GREGORY HUDSON MD INC
Entity Type:Organization
Organization Name:GREGORY HUDSON MD INC
Other - Org Name:CHRIST CARE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-932-2079
Mailing Address - Street 1:137 STATE ROUTE 3117
Mailing Address - Street 2:
Mailing Address - City:SOUTH SHORE
Mailing Address - State:KY
Mailing Address - Zip Code:41175
Mailing Address - Country:US
Mailing Address - Phone:606-932-2079
Mailing Address - Fax:606-932-2313
Practice Address - Street 1:137 STATE ROUTE 3117
Practice Address - Street 2:
Practice Address - City:SOUTH SHORE
Practice Address - State:KY
Practice Address - Zip Code:41175
Practice Address - Country:US
Practice Address - Phone:606-932-2079
Practice Address - Fax:606-932-2313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0433890Medicaid
KY36D0683301OtherCLIA
KYK182002OtherPTAN
KY7100373950Medicaid
KY7100373960Medicaid
KY7100724490Medicaid
OH36D2062943OtherCLIA
OH0243927Medicaid