Provider Demographics
NPI:1477932036
Name:SAMARITAN FAMILY CARE, INC
Entity Type:Organization
Organization Name:SAMARITAN FAMILY CARE, INC
Other - Org Name:GEM CITY SURGICAL HERNIA CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
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:937-499-8205
Mailing Address - Street 1:9000 N MAIN ST
Mailing Address - Street 2:STE 233B
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-832-9310
Mailing Address - Fax:937-832-8613
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:STE 233B
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-832-9310
Practice Address - Fax:937-832-8613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0081307Medicaid
OH9931742Medicare PIN