=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972625606
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAMARITAN FAMILY CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 11/08/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6251 GOOD SAMARITAN WAY SUITE 210B
-----------------------------------------------------
City | HUBER HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45424-5253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-233-2055
-----------------------------------------------------
Fax | 937-233-5479
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6251 GOOD SAMARITAN WAY SUITE 210B
-----------------------------------------------------
City | HUBER HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45424-5253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-233-2055
-----------------------------------------------------
Fax | 937-233-5479
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO PRESIDENT
-----------------------------------------------------
Name | KENNETH PRUNIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 937-208-8252
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------