Provider Demographics
NPI:1790730588
Name:MEDICAL EMERGENCY TRAUMA ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:MEDICAL EMERGENCY TRAUMA ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUTCHINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-944-7417
Mailing Address - Street 1:12911 CANTRELL RD.
Mailing Address - Street 2:SUITE 7-135
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223
Mailing Address - Country:US
Mailing Address - Phone:501-944-7417
Mailing Address - Fax:
Practice Address - Street 1:TWO SAINT VINCENT CIRCLE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5449
Practice Address - Country:US
Practice Address - Phone:501-552-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121325002Medicaid
AR5B190OtherBCBS
AR5B190Medicare ID - Type Unspecified