Provider Demographics
NPI:1134175078
Name:HUDSON PHYSICIANS ASSOC INC
Entity type:Organization
Organization Name:HUDSON PHYSICIANS ASSOC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:CANTONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-745-1611
Mailing Address - Street 1:PO BOX 74382
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0002
Mailing Address - Country:US
Mailing Address - Phone:614-430-5727
Mailing Address - Fax:
Practice Address - Street 1:155 5TH ST NE
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-3332
Practice Address - Country:US
Practice Address - Phone:330-745-1611
Practice Address - Fax:330-848-7795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2281294Medicaid
CJ5644OtherMEDICARE RAILROAD
OH9318261Medicare PIN