Provider Demographics
NPI:1376518837
Name:GEORGETOWN MEDICAL, PC
Entity Type:Organization
Organization Name:GEORGETOWN MEDICAL, PC
Other - Org Name:GEORGETOWN MEDICAL, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:HUTFLESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-556-3000
Mailing Address - Street 1:3440 S 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3829
Mailing Address - Country:US
Mailing Address - Phone:402-556-3000
Mailing Address - Fax:402-991-7115
Practice Address - Street 1:3440 S 50TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3829
Practice Address - Country:US
Practice Address - Phone:402-556-3000
Practice Address - Fax:402-991-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE218816123171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2801-1204Medicaid
NE18358OtherSTATE LIC.# G. HUTFLESS
NE1891765004OtherGEORGE HUTFLESS,MD NPI #
NE2801-18358Medicaid
IA2965301Medicaid
NE508741492OtherGEORGE HUTFLESS S.SEC. #
NE508741492OtherGEORGE HUTFLESS S.SEC. #
NE2801-1204Medicaid
NE2801-1204Medicaid
NE18358OtherSTATE LIC.# G. HUTFLESS
NEBH1434050OtherDEA# GEORGE HUTFLESS MD
NE275425Medicare ID - Type UnspecifiedG. HUTFLESS MEDICARE #
NE=========00Medicaid