1235182668 NPI number — SAMARITAN FAMILY CARE INC

Table of content: (NPI 1235182668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235182668 NPI number — SAMARITAN FAMILY CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMARITAN FAMILY CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HUBER HEIGHTS SAMARITAN PEDIATRICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235182668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3170 KETTERING BLVD BLDG B3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORAINE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45439-1924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-991-3100
Provider Business Mailing Address Fax Number:
937-233-8389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6251 GOOD SAMARITAN WAY
Provider Second Line Business Practice Location Address:
SUITE 210C
Provider Business Practice Location Address City Name:
HUBER HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45424-1051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-233-3910
Provider Business Practice Location Address Fax Number:
937-233-8389
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRUNIER
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
937-208-8213

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0230502 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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