Active NPI
Jonathan Hudson, CSFA
- Surgical Assistant
- Tyler, TX
National Provider Identifier
1700535630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 208501
- Practice address
- 630 S Fleishel Ave
Tyler, TX 75701-2041 - Phone
- (903) 606-5560
- NPI assigned
- Mar 18, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Respiratory/Developmental/Rehabilitative Specialist/Technologist | 225500000X | |||
| Surgical Assistant | 246ZC0007X | 208501 | TX | Primary |
Addresses
Primary practice location
630 S Fleishel Ave
Tyler, TX 75701-2041
Mailing address
630 S Fleishel Ave
Tyler, TX 75701-2041
Phone (903) 606-5560
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 208501 | TX | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652313600000",
"number": "1700535630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 S FLEISHEL AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757012041",
"telephone_number": "903-606-5560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 S FLEISHEL AVE",
"city": "TYLER",
"state": "TX",
"postal_code": "757012041",
"telephone_number": "903-606-5560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUDSON",
"first_name": "JONATHAN",
"credential": "CSFA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-03-18",
"last_updated": "2022-05-12",
"certification_date": "2022-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "225500000X",
"taxonomy_group": "",
"desc": "Specialist/Technologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "TX",
"license": "208501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.