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	207R00000X	Internal Medicine 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	:	1972625606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMARITAN FAMILY CARE INC

Provider Business Mailing Address
First Line	:	6251 GOOD SAMARITAN WAY
Second Line	:	SUITE 210B
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-5253
Country	:	US
Telephone Number	:	937-233-2055
Fax Number	:	937-233-5479

Provider Business Practice Location Address
First Line	:	6251 GOOD SAMARITAN WAY
Second Line	:	SUITE 210B
City	:	HUBER HEIGHTS
State	:	OH
Zip	:	45424-5253
Country	:	US
Telephone Number	:	937-233-2055
Fax Number	:	937-233-5479

Authorized Official
Title or Position	:	CEO PRESIDENT
Name	:	KENNETH PRUNIER
Credential	:
Telephone Number	:	937-208-8252

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	11/08/2013

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Directions to “SAMARITAN FAMILY CARE INC ” Practice Location

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