Organization
PRUETT MEDICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE C PRUETT (PRESIDENT/C.O.B.)
(254) 772-0040
Entity
Organization
Contact information
Practice address
6813 CACTUS, WACO, TX 76712-6160
(254) 772-0040
(254) 772-1110
Mailing address
PO BOX 21445, WACO, TX 76702-1445
(254) 772-0040
(254) 772-1110
Taxonomy
Speciality
Code
Description
License number
State
332BN1400X
Nursing Facility Supplies (DME)
0034661
TX
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
0034661
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000508611
BLUE CROSS BLUE SHIELD TX
—
01
—
0005231045
AETNA
—
01
—
J09900025015
SIERRA HEALTH AND LIFE
—
Enumeration date
07/06/2006
Last updated
09/11/2025
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