Provider Demographics
NPI:1558316638
Name:SAMARITAN FAMILY CARE INC
Entity Type:Organization
Organization Name:SAMARITAN FAMILY CARE INC
Other - Org Name:SAMARITAN HOSPITALIST GROUP
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 1:2200 PHILADELPHIA DR
Mailing Address - Street 2:STE 441
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1840
Mailing Address - Country:US
Mailing Address - Phone:937-734-2230
Mailing Address - Fax:937-567-4186
Practice Address - Street 1:2200 PHILADELPHIA DR
Practice Address - Street 2:STE 441
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1840
Practice Address - Country:US
Practice Address - Phone:937-734-2230
Practice Address - Fax:937-567-4186
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMARITAN FAMILY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-24
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2602133Medicaid
OH9931742Medicare PIN