Provider Demographics
NPI:1629630504
Name:BAC MEDICAL, PLLC
Entity Type:Organization
Organization Name:BAC MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TRUITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:267-282-6680
Mailing Address - Street 1:3070 BRISTOL PIKE # 2-130
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5364
Mailing Address - Country:US
Mailing Address - Phone:267-282-6680
Mailing Address - Fax:267-282-6677
Practice Address - Street 1:3070 BRISTOL PIKE # 2-130
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5364
Practice Address - Country:US
Practice Address - Phone:267-282-6680
Practice Address - Fax:267-282-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty