Phoenix Health Care

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301091092 Issued in MI

Legal business name

PHOENIX HEALTH CARE

Practice address

10475 W Jefferson Ave
River Rouge, MI 48218-1331

Phone

(313) 342-8421

NPI assigned

Nov 9, 2012

Last updated

Nov 9, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gerald Hudson, MD

Title

Owner

Phone

(313) 342-8421

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352419200000",
    "number": "1366796567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10475 W JEFFERSON AVE",
            "city": "RIVER ROUGE",
            "state": "MI",
            "postal_code": "482181331",
            "telephone_number": "313-342-8421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10475 W JEFFERSON AVE",
            "city": "RIVER ROUGE",
            "state": "MI",
            "postal_code": "482181331",
            "telephone_number": "313-342-8421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-09",
        "last_updated": "2012-11-09",
        "status": "A",
        "authorized_official_last_name": "HUDSON",
        "authorized_official_first_name": "GERALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-342-8421",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301091092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in River Rouge, MI
• Providers in River Rouge, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.