Provider Demographics
NPI:1467643601
Name:CRAIG D BARTRUFF, M.D., P.C.
Entity Type:Organization
Organization Name:CRAIG D BARTRUFF, M.D., P.C.
Other - Org Name:GOTHENBURG MEDICAL ARTS RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:D
Authorized Official - Last Name:BARTRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-537-3673
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:GOTHENBURG
Mailing Address - State:NE
Mailing Address - Zip Code:69138-0389
Mailing Address - Country:US
Mailing Address - Phone:308-537-3673
Mailing Address - Fax:308-537-3673
Practice Address - Street 1:619 10TH ST
Practice Address - Street 2:
Practice Address - City:GOTHENBURG
Practice Address - State:NE
Practice Address - Zip Code:69138-2063
Practice Address - Country:US
Practice Address - Phone:308-537-3673
Practice Address - Fax:308-537-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid