Provider Demographics
NPI:1417902982
Name:SAMARITAN FAMILY CARE INC
Entity Type:Organization
Organization Name:SAMARITAN FAMILY CARE INC
Other - Org Name:PHILLIPSBURG FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
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:937-208-8213
Mailing Address - Street 1:P O BOX 488
Mailing Address - Street 2:201 N LUDLOW STREET
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45354
Mailing Address - Country:US
Mailing Address - Phone:937-884-5112
Mailing Address - Fax:937-884-7855
Practice Address - Street 1:201 N LUDLOW STREET
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:OH
Practice Address - Zip Code:45354
Practice Address - Country:US
Practice Address - Phone:937-884-5112
Practice Address - Fax:937-884-7855
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMARITAN FAMILY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0230664Medicaid
OH9931746Medicare PIN
9931742Medicare PIN