Provider Demographics
NPI:1073738035
Name:GEORGE R HUTCHISON, MD ,PA
Entity Type:Organization
Organization Name:GEORGE R HUTCHISON, MD ,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-860-6130
Mailing Address - Street 1:PO BOX 665
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-0665
Mailing Address - Country:US
Mailing Address - Phone:501-860-6130
Mailing Address - Fax:501-860-6054
Practice Address - Street 1:1701 S SHACKLEFORD RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4335
Practice Address - Country:US
Practice Address - Phone:501-219-7904
Practice Address - Fax:501-860-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE0818OtherELECTRONIC SUBMITTER
AR50056Medicare ID - Type UnspecifiedMEDICARE