Provider Demographics
NPI:1285687392
Name:AMERICAN HEALTHCARE NETWORK, INC.
Entity Type:Organization
Organization Name:AMERICAN HEALTHCARE NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-477-3851
Mailing Address - Street 1:PO BOX 28029
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-8029
Mailing Address - Country:US
Mailing Address - Phone:215-477-3851
Mailing Address - Fax:
Practice Address - Street 1:5070 PARKSIDE AVE
Practice Address - Street 2:SUITE 5101, BOX 48
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-4747
Practice Address - Country:US
Practice Address - Phone:215-477-3851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30032107OtherKEYSTONE MERCY HEALTH
PA1015656270001Medicaid
PA0000333000OtherINDEPENDENCE BCBS
PA36501OtherHEALTH PARTNERS PA
PA1015656270001Medicaid