SAMARITAN FAMILY CARE LLC

Provider Demographics

• NPI: 1629536206
• Name: SAMARITAN FAMILY CARE LLC
• Entity Type: Organization
• Organization Name: SAMARITAN FAMILY CARE LLC
• Authorized Official - Title/Position: OWNER
• Authorized Official - Prefix: DR
• Authorized Official - First Name: ANTOIN
• Authorized Official - Middle Name: N
• Authorized Official - Last Name: HANA
• Authorized Official - Credentials: MD/OWNER
• Authorized Official - Phone: 606-349-8100
• Mailing Address - Street 1: PO BOX 697
• Mailing Address - City: PRESTONSBURG
• Mailing Address - State: KY
• Mailing Address - Zip Code: 41653-0697
• Mailing Address - Country: US
• Mailing Address - Phone: 606-874-2300
• Mailing Address - Fax: 606-874-2888
• Practice Address - Street 1: 713 BROADWAY ST STE 301A
• Practice Address - City: PAINTSVILLE
• Practice Address - State: KY
• Practice Address - Zip Code: 41240-1465
• Practice Address - Country: US
• Practice Address - Phone: 606-372-1234
• Practice Address - Fax: 606-372-1240
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2019-03-04
• Last Update Date: 2021-12-30

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	101Y00000X	Behavioral Health & Social Service Providers	Counselor		Group - Multi-Specialty
No	104100000X	Behavioral Health & Social Service Providers	Social Worker		Group - Multi-Specialty
No	207QA0505X	Allopathic & Osteopathic Physicians	Family Medicine	Adult Medicine	Group - Multi-Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	225X00000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Occupational Therapist		Group - Multi-Specialty
No	235500000X	Speech, Language and Hearing Service Providers	Specialist/Technologist		Group - Multi-Specialty
No	235Z00000X	Speech, Language and Hearing Service Providers	Speech-Language Pathologist		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Multi-Specialty
No	363LP2300X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Primary Care	Group - Multi-Specialty
No	363LP0808X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Psychiatric/Mental Health	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KY	7100600430	Medicaid
KY	7100600040	Medicaid
KY	7100702010	Medicaid
KY	7100712610	Medicaid
KY	7100730130	Medicaid
KY	7100706120	Medicaid
KY	7100596740	Medicaid
KY	7100727750	Medicaid
KY	7100729800	Medicaid
KY	7100600030	Medicaid
KY	7100730140	Medicaid