# SAMUEL L HUDSON MDPA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609002518
- **Authorized official:** MRS. CAMILLE HUDSON (MANAGER)
- **Authorized official phone:** (979) 299-6900

## Contact information

- **Practice address:** 120 FLAG LAKE DR, LAKE JACKSON, TX 77566-6292
- **Practice address phone:** (979) 299-6900
- **Practice address fax:** (979) 299-6903
- **Mailing address:** PO BOX 4165, LAKE JACKSON, TX 77566-2065
- **Mailing address phone:** (979) 299-6900
- **Mailing address fax:** (979) 299-6903

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | F4099 | TX | Yes |

## Other

- **Enumeration date:** 06/05/2009
- **Last updated:** 06/05/2009