Provider Demographics
NPI:1073959102
Name:BART PRUITT DO
Entity Type:Organization
Organization Name:BART PRUITT DO
Other - Org Name:DR BART PRUITT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BART
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-342-9800
Mailing Address - Street 1:PO BOX 12251
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4013
Mailing Address - Country:US
Mailing Address - Phone:903-342-9800
Mailing Address - Fax:903-342-9809
Practice Address - Street 1:719 W COKE RD
Practice Address - Street 2:MOB 2
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-3060
Practice Address - Country:US
Practice Address - Phone:903-342-9800
Practice Address - Fax:903-342-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3403261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
320276Medicare Oscar/Certification