Provider Demographics
NPI:1851344501
Name:SAMARITAN FAMILY CARE, INC.
Entity Type:Organization
Organization Name:SAMARITAN FAMILY CARE, INC.
Other - Org Name:BROOKVILLE 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 1:950 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-8227
Mailing Address - Country:US
Mailing Address - Phone:937-833-4581
Mailing Address - Fax:937-833-5359
Practice Address - Street 1:950 SALEM ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-8227
Practice Address - Country:US
Practice Address - Phone:937-833-4581
Practice Address - Fax:937-833-5359
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMARITAN FAMILY CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
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
OH0224537Medicaid
OH9931742Medicare PIN
OH0224537Medicaid