Provider Demographics
NPI:1972625606
Name:SAMARITAN FAMILY CARE INC
Entity Type:Organization
Organization Name:SAMARITAN FAMILY CARE INC
Other - Org Name:HUBER HEIGHTS INTERNAL MEDICINE
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:937-208-8252
Mailing Address - Street 1:6251 GOOD SAMARITAN WAY
Mailing Address - Street 2:SUITE 210B
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-5253
Mailing Address - Country:US
Mailing Address - Phone:937-233-2055
Mailing Address - Fax:937-233-5479
Practice Address - Street 1:6251 GOOD SAMARITAN WAY
Practice Address - Street 2:SUITE 210B
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-5253
Practice Address - Country:US
Practice Address - Phone:937-233-2055
Practice Address - Fax:937-233-5479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMARITAN FAMILY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-04
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0372878Medicaid
OH9931742Medicare PIN
OH9368451Medicare PIN