1376518837 NPI number — GEORGETOWN MEDICAL, PC

Table of content: (NPI 1376518837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376518837 NPI number — GEORGETOWN MEDICAL, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGETOWN MEDICAL, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376518837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3440 S 50TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68106-3829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-556-3000
Provider Business Mailing Address Fax Number:
402-991-7115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3440 S 50TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68106-3829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-556-3000
Provider Business Practice Location Address Fax Number:
402-991-7115
Provider Enumeration Date:
02/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUTFLESS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
STANLEY
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
402-556-3000

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X , with the licence number:  218816123 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2801-1204 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18358 . This is a "STATE LIC.# G. HUTFLESS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1891765004 . This is a "GEORGE HUTFLESS,MD NPI #" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 2801-18358 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2965301 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 508741492 . This is a "GEORGE HUTFLESS S.SEC. #" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com