Basic Information
| Provider Information | |||||||||
| NPI: | 1891765004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUTFLESS | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | STANLEY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3440 S 50TH ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681063829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025563000 | ||||||||
| FaxNumber: | 4029917115 | ||||||||
| Practice Location | |||||||||
| Address1: | 3440 S 50TH ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681063829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025563000 | ||||||||
| FaxNumber: | 4029917115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 03/31/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 18358 | NE | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00373 | 01 | NE | BLUE CROSS BLUE SHIELD | OTHER | 47084517200 | 05 | NE | MEDICAID | BH1434050 | 01 | NE | CONTROLLED SUBSTANCE DEA# | OTHER | 04-00021 | 01 | NE | UNITED HEALTHCARE | OTHER | 18358 | 05 | NE | MEDICAID | 18358 | 01 | NE | NEBRASKA STATE LICENSE # | OTHER | 11602 | 01 | NE | MIDLANDS CHOICE PROVIDER | OTHER | 2965301 | 05 | IA | MEDICAID |