MEDICARE: SAMARITAN FAMILY CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558316638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN FAMILY CARE INC

Provider Business Mailing Address
First Line	:	2200 PHILADELPHIA DR
Second Line	:	STE 441
City	:	DAYTON
State	:	OH
Zip	:	45406-1840
Country	:	US
Telephone Number	:	937-734-2230
Fax Number	:	937-567-4186

Provider Business Practice Location Address
First Line	:	2200 PHILADELPHIA DR
Second Line	:	STE 441
City	:	DAYTON
State	:	OH
Zip	:	45406-1840
Country	:	US
Telephone Number	:	937-734-2230
Fax Number	:	937-567-4186

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	KENNETH PRUNIER
Credential	:
Telephone Number	:	937-208-8213

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	11/11/2014

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