| Organization Name: | BART PRUITT DO |
| NPI Number: | 1073959102 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BART PRUITT (OWNER) |
| Mailing Address: | 719 W Coke Rd Mob 2 Winnsboro |
| State: | TX US |
| Postal Code: | 754943060 |
| Phone Number: | 9033429800 |
| Fax Number: | 9033429809 |
| NPI Enumeration Date: | 05/15/2013 |
| NPI Last Update Date: | 05/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | K3403 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |