1720161086 NPI number — SAMARITAN FAMILY CARE INC

Table of content: DR. JASON SCOTT HART PSYD (NPI 1710406913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720161086 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:
Provider Other Organization Name Type Code:
6
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:
1720161086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
810 FALLS CREEK DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
VANDALIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45377-8600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-454-0317
Provider Business Mailing Address Fax Number:
937-454-1668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 FALLS CREEK DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
VANDALIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45377-8600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-454-0317
Provider Business Practice Location Address Fax Number:
937-454-1668
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRUNIER
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/PRESIDEN
Authorized Official Telephone Number:
937-208-8273

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2552134 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com