Provider Demographics
NPI:1699022319
Name:SAMARITAN FAMILY CARE INC
Entity type:Organization
Organization Name:SAMARITAN FAMILY CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-499-8213
Mailing Address - Street 1:80 E WOODBURY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2800
Mailing Address - Country:US
Mailing Address - Phone:937-278-2303
Mailing Address - Fax:937-278-2662
Practice Address - Street 1:80 E WOODBURY DR
Practice Address - Street 2:SUITE B
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2800
Practice Address - Country:US
Practice Address - Phone:937-278-2303
Practice Address - Fax:937-278-2662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMARITAN FAMILY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-13
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0072145Medicaid
OH0072145Medicaid