Healthcare Provider Details

I. General information

NPI: 1467407544
Provider Name (Legal Business Name): SAMARITAN FAMILY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6251 GOOD SAMARITAN WAY SUITE 210A
HUBER HEIGHTS OH
45424-1051
US

IV. Provider business mailing address

6251 GOOD SAMARITAN WAY SUITE 210A
HUBER HEIGHTS OH
45424
US

V. Phone/Fax

Practice location:
  • Phone: 937-233-2009
  • Fax: 937-233-8389
Mailing address:
  • Phone: 937-233-2009
  • Fax: 937-233-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH PRUNIER
Title or Position: CEO/PRESIDENT
Credential:
Phone: 937-208-8213