Provider Demographics
NPI:1518585454
Name:RUFFER, SAMANTHA (HCA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:RUFFER
Suffix:
Gender:F
Credentials:HCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2851 COUNTY ROAD 21
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-9505
Mailing Address - Country:US
Mailing Address - Phone:419-583-6291
Mailing Address - Fax:
Practice Address - Street 1:2851 COUNTY ROAD 21
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-9505
Practice Address - Country:US
Practice Address - Phone:419-583-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102627Medicaid