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General NPI Number Information
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NPI Number | 1194756296
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Entity Type | Organization
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Legal Business Name | PRUETT MEDICAL, INC.
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 6813 CACTUS
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City | WACO
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State | TX
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Zip | 76712-6160
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Country | US
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Telephone | 254-772-0040
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Fax | 254-772-1110
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Provider Business Mailing Address
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Address Line | PO BOX 21445
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City | WACO
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State | TX
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Zip | 76702-1445
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Country | US
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Telephone | 254-772-0040
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Fax | 254-772-1110
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Authorized Official
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Title or Position | PRESIDENT/C.O.B.
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Name | ANNE C PRUETT
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Credential |
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Telephone | 254-772-0040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number | 0034661
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 0034661
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License Number State | TX
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