Organization
WESTERN WISCONSIN MEDICAL ASSOCIATES HUDSON LTD
Active
Parent organization
WESTERN WISCONSIN MEDICAL ASSOCIATES HUDSON LTD
Other names
Hudson Physicians
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN WISCONSIN MEDICAL ASSOCIATES HUDSON LTD
Authorized official
ERNIE WALLIN (ADMINISTRATOR DIRECTOR)
(715) 531-6800
Entity
Organization
Contact information
Practice address
403 STAGELINE ROAD, HUDSON, WI 54016
(715) 531-6800
(715) 531-6801
Mailing address
403 STAGELINE ROAD, HUDSON, WI 54016
(715) 531-6800
(715) 531-6801
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
WI
291U00000X
Clinical Medical Laboratory
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32723100
—
WI
01
—
56125
MEDICARE
WI
Enumeration date
03/29/2006
Last updated
10/13/2009
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