Provider Demographics
NPI:1467405332
Name:SAMARITAN FAMILY CARE INC
Entity Type:Organization
Organization Name:SAMARITAN FAMILY CARE INC
Other - Org Name:VANDALIA 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 1:1 W NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-1932
Mailing Address - Country:US
Mailing Address - Phone:937-208-7776
Mailing Address - Fax:937-208-7751
Practice Address - Street 1:1 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1932
Practice Address - Country:US
Practice Address - Phone:937-208-7776
Practice Address - Fax:937-208-7751
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMARITAN FAMILY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2029898Medicaid
OH9931742Medicare PIN